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General NPI Number Information
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NPI Number | 1053815274
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Entity Type | Individual
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Provider Name | SHANNON ELIZABETH MICHEL WYNN MD
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Gender | Female
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 282 WASHINGTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-3322
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Country | US
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Telephone | 860-545-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 282 WASHINGTON ST
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City | HARTFORD
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State | CT
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Zip | 06106-3322
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Country | US
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Telephone | 860-545-9000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | 74367
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | 74367
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License Number State | CT
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