Healthcare Provider Details

I. General information

NPI: 1508424854
Provider Name (Legal Business Name): JAMIE CHRISTINE SHAWVER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2019
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SOUTH RD STE 200
FARMINGTON CT
06032-2483
US

IV. Provider business mailing address

11 SOUTH RD STE 200
FARMINGTON CT
06032-2483
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-9544
  • Fax: 860-284-9548
Mailing address:
  • Phone: 860-284-9544
  • Fax: 860-284-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1.076096
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1.076096
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: