Healthcare Provider Details

I. General information

NPI: 1629590153
Provider Name (Legal Business Name): SHANNON MARIE LYNCH APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

IV. Provider business mailing address

1 CELLINI PL STE 102
WEST HAVEN CT
06516-1666
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-6481
  • Fax: 203-932-4051
Mailing address:
  • Phone: 203-932-6481
  • Fax: 203-932-4051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7083
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7083
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: