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NPI Code Detail

MEDICARE: SHANNON ELIZABETH MICHEL WYNN MD

MEDICARE: SHANNON ELIZABETH MICHEL WYNN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080H0002XPediatric Hospice and Palliative Medicine Physician74367CT
2207RH0002XHospice and Palliative Medicine (Internal Medicine) Physician74367CT

General Provider Information

NPI Number : 1053815274
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON ELIZABETH MICHEL WYNN MD
Provider Business Mailing Address
First Line : 282 WASHINGTON ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3322
Country : US
Telephone Number : 860-545-9000
Fax Number :
Provider Business Practice Location Address
First Line : 282 WASHINGTON ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3322
Country : US
Telephone Number : 860-545-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2018
Last Update Date : 12/09/2025

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