MEDICARE: SHANNON LEIGH MAXON PA-C

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	363A00000X	Physician Assistant	001221	CT

General Provider Information

NPI Number	:	1407900566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON LEIGH MAXON PA-C

Provider Business Mailing Address
First Line	:	33 COSEY BEACH AVE
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512
Country	:	US
Telephone Number	:	413-530-1813
Fax Number	:	203-867-5509

Provider Business Practice Location Address
First Line	:	33 COSEY BEACH AVE
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-4905
Country	:	US
Telephone Number	:	413-530-1813
Fax Number	:	203-867-5509

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

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	02/22/2016

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Directions to “ SHANNON LEIGH MAXON PA-C” Practice Location

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