Provider Demographics
NPI:1366263634
Name:CONNIFF, SHAI
Entity type:Individual
Prefix:
First Name:SHAI
Middle Name:
Last Name:CONNIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ROBIN RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3250
Mailing Address - Country:US
Mailing Address - Phone:860-920-8894
Mailing Address - Fax:
Practice Address - Street 1:10 BIRDSEYE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2489
Practice Address - Country:US
Practice Address - Phone:860-678-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner