Healthcare Provider Details

I. General information

NPI: 1053815274
Provider Name (Legal Business Name): SHANNON ELIZABETH MICHEL WYNN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON ELIZABETH MICHEL

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-9000
  • Fax:
Mailing address:
  • Phone: 860-545-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number74367
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number74367
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: