Provider Demographics
NPI:1477430585
Name:MALIK, SHANAG (APRN)
Entity type:Individual
Prefix:
First Name:SHANAG
Middle Name:
Last Name:MALIK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARINER CIR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1722
Mailing Address - Country:US
Mailing Address - Phone:203-414-1974
Mailing Address - Fax:
Practice Address - Street 1:300 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4703
Practice Address - Country:US
Practice Address - Phone:203-226-2490
Practice Address - Fax:203-226-2491
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15229363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner