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General NPI Number Information
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NPI Number | 1740579952
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Entity Type | Individual
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Provider Name | MRS. SHANNIELLE ANTONELLI
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Gender | Female
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Dates
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Enumeration Date | 03/29/2011
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Last Update Date | 03/29/2011
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Provider Practice Location Address
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Address Line | 10 HEMINGWAY AVE
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City | EAST HAVEN
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State | CT
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Zip | 06512-3404
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Country | US
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Telephone | 203-469-4609
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Fax |
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Provider Business Mailing Address
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Address Line | 600 WASHINGTON AVE UNIT #A8
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City | NORTH HAVEN
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State | CT
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Zip | 06473-1100
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Country | US
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Telephone |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0011420
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License Number State | CT
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