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General NPI Number Information
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NPI Number | 1275334922
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Entity Type | Individual
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Provider Name | MRS. SHADDAE GENEVA JACKSON-CONNOR
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Gender |
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 1000 BRIDGEPORT AVE STE 405
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City | SHELTON
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State | CT
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Zip | 06484-4660
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Country | US
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Telephone | 203-993-6592
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Fax |
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Provider Business Mailing Address
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Address Line | 184 MORNING DOVE RD
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City | NAUGATUCK
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State | CT
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Zip | 06770-4807
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Country | US
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Telephone | 929-620-3503
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1291732
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License Number State | CT
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