Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD 049538 | CT |
N | 208600000X | Surgeon | MD 049538 | CT |
N | 208200000X | Surgeon | MT185935 | PA |
N | 208600000X | Surgeon | MT185935 | PA |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 049538 | CT |
NPI | 1265598130 |
---|---|
Provider Name | Shareef Jandali |
First Address | Trumbull, CT 06611-3463 |
Second Address | Trumbull, CT 06611-3463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 11/10/2019 |