DR. SHAWNA MARIE KETTYLE (NPI# 1811253321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811253321 |
| Entity Type | Individual |
| Full Name | DR. SHAWNA MARIE KETTYLE |
| Credential | M.D. |
| Practice Address |
2800 Main St Dept Of Bridgeport CT 06606 |
| Mailing Address |
2800 Main St Dept Of Bridgeport CT 06606-4292 |
| Practice Telephone | 2035766000 |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2018-07-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 61673 | CT | Allopathic & Osteopathic Physicians |
| Street Address |
2800 MAIN ST DEPT OF |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437314648 | Saurabh Malhotra | Pathology | 2800 Main St Dept Of, Bridgeport, CT 06606-4201 | 2008-07-28 |
| 1467072868 | Mahmoud Abdelrahman | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4292 | 2020-04-26 |
| 1659991628 | Sara Yumeen | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4292 | 2020-04-20 |
| 1598384547 | Buadi Kofi Tandoh | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4292 | 2020-04-09 |
| 1396374724 | Justyna M Michalik | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4201 | 2020-04-07 |
| 1447712187 | Armando A Vera | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4201 | 2019-04-02 |
| 1801356100 | Magdelene Doris Amoateng | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4201 | 2019-03-22 |
| 1114487485 | Rishi Chadha | Student in an Organized Health Care Education/Training Program | 2800 Main St Dept Of, Bridgeport, CT 06606-4201 | 2019-03-22 |
| 1508396763 | Jose Pichardo Castillo | Internal Medicine | 2800 Main St Dept Of, Bridgeport, CT 06606-4201 | 2017-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962023408 | Madeline Acquilano | Pharmacist | 2800 East Main St, Bridgeport, CT 06606 | 2020-05-06 |
| 1578192001 | Karin Alexandra Skalina | Student in an Organized Health Care Education/Training Program | 2800 Main St., Dept. of Medicine, Bridgeport, CT 06606 | 2020-04-06 |
| 1720641293 | Valeriia Klymenko | Student in an Organized Health Care Education/Training Program | 2800 Main Street, Department of Medicine, Bridgeport, CT 06606 | 2019-04-19 |
| 1821579996 | Ashley Liese | Nurse Practitioner | Cardiology Physicians of Fairfield County, 2679 Main St, Bridgeport, CT 06606 | 2018-08-27 |
| 1699261289 | Gema Estefania Giler-sacoto | Student in an Organized Health Care Education/Training Program | St. Vincent's Medical Center, 2800 Main Street, Department of Medicine, Bridgeport, CT 06606 | 2018-07-06 |
| 1114418365 | Jona Bumci | Physician Assistant | 3180 Main St Ste 304, Bridgeport, CT 06606 | 2018-05-23 |
| 1023471299 | Qmg4, LLC | Family Medicine | 4200 Main Street, Bridgeport, CT 06606 | 2016-04-04 |
| 1861867442 | Marie Dorothea Lisieski | Social Worker | 2400 Main Street, Bridgeport, CT 06606 | 2015-12-08 |
| 1548603384 | Gerald E. Hedley | Internal Medicine | 390 Charles Street Unit #101, Bridgeport, CT 06606 | 2013-04-11 |
| 1487997581 | Gerald Micalizzi, M.d., LLC | Radiology | 558 Fairview Avenue, Bridgeport, CT 06606 | 2013-03-27 |
| Find all providers in zip 06606 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518319458 | Muhammad Umer Afzaal | Surgery | 267 Grant St Fl St4, Bridgeport, CT 06610-2805 | 2016-07-04 |
| 1316378615 | Artem Dyatlov | Surgery | 2660 Main St Ste 110, Bridgeport, CT 06606-5301 | 2013-12-11 |
| 1952507972 | Sugam B Vasani | Surgery | 527 Medical Park Dr Ste 202, Bridgeport, WV 26330-9009 | 2007-06-26 |
| 1841350964 | Richard J Garvey | Surgery | 310 Mill Hill Ave, Bridgeport, CT 06610-2863 | 2006-12-11 |
| 1528136785 | Subhash O Shah | Surgery | 310 Mill Hill Avenue, Bridgeport, CT 06484 | 2006-12-04 |
| 1134193840 | Adam J Hansen | Surgery | 527 Medical Park Dr Ste 205, Bridgeport, WV 26330-9009 | 2006-02-17 |
| 1780678227 | Stuart Marcus | Surgery | 2800 Main St, St. Vincent's Medical Center, Bridgeport, CT 06606-4201 | 2005-09-09 |
| 1891131595 | Imran Baig | Surgery | 2800 Main St, Bridgeport, CT 06606 | 2013-05-21 |
| 1194089946 | Benjamin A Raymond | Surgery | 527 Medical Park Dr Ste 202, Bridgeport, WV 26330-9009 | 2012-06-26 |
| 1720349905 | United Hospital Center, Inc. | Surgery | 527 Medical Park Dr Ste 202, Bridgeport, WV 26330-9009 | 2012-06-04 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06606 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.