Healthcare Provider Details

I. General information

NPI: 1720035041
Provider Name (Legal Business Name): SHANNON LEE AYOTTE STAUFFER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 BURBANK AVE
SUFFIELD CT
06078-1459
US

IV. Provider business mailing address

880 BURBANK AVE
SUFFIELD CT
06078-1459
US

V. Phone/Fax

Practice location:
  • Phone: 860-989-7875
  • Fax: 866-256-1692
Mailing address:
  • Phone: 860-989-7875
  • Fax: 866-256-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006144
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: