Tejal Kothari Shaikh, D.O.
Individual provider Active NPI Family Medicine Physician · East Granby, CT
NPI 1508312893 · NPPES record last updated Jul 12, 2023
Key facts
- NPI
- 1508312893
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 66749 (CT)
- Practice address
- 13 Church Rd
East Granby, CT 06026-9406 - Phone
- (860) 653-4526
- NPI assigned
- Aug 28, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- East Granby Family Practice LLC
McLean Fund
Practice addresses (Care Compare)
13 Church Rd
East Granby, CT 06026-9406
Phone (860) 653-4526
75 Great Pond Rd
Simsbury, CT 06070-1980
Hospital & facility affiliations
- Hartford Healthcare at Home
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201130002129 | CT | Practitioner - Family Practice | 5092126870 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66749 | CT | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| East Granby Family Practice LLC | Family Medicine | Current |
Accepting new patients |
Locations
13 Church Rd
East Granby, CT 06026
Phone (860) 653-4526
Interoperability endpoints
- tejal.shaikh.1@28841.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 66749 | CT | Yes |
Addresses
Primary practice location
13 Church Rd
East Granby, CT 06026-9406
Mailing address
PO Box 518
East Granby, CT 06026-0518
Phone (860) 653-4526
Other providers in East Granby, CT
- Elliot S Pollack
- Reese'S Remedy Resources, LLC
- Anne M Reiher
- Lindsey M Rohner
- Alisa Lynn Ruggiero
- Perry M Siegel
- Smiles on the Go RDH, LLC
- Laura Smith
- Sojourn Counseling LLC
- Tatum Strong
All providers in East Granby, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.