MEDICARE: SHANNON ELIZABETH EAMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1836	CT

General Provider Information

NPI Number	:	1356155097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON ELIZABETH EAMES

Provider Business Mailing Address
First Line	:	20 ELIZABETH RD
Second Line	:
City	:	CANTON
State	:	CT
Zip	:	06019-2601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 ELIZABETH RD
Second Line	:
City	:	CANTON
State	:	CT
Zip	:	06019-2601
Country	:	US
Telephone Number	:	845-751-9070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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Directions to “ SHANNON ELIZABETH EAMES ” Practice Location

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