MEDICARE: SHANNON KATHLEEN PADGETT

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	390200000X	Student in an Organized Health Care Education/Training Program		MA

General Provider Information

NPI Number	:	1457290843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON KATHLEEN PADGETT

Provider Business Mailing Address
First Line	:	200 RETREAT AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3309
Country	:	US
Telephone Number	:	860-545-7828
Fax Number	:	860-545-7988

Provider Business Practice Location Address
First Line	:	200 RETREAT AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-3309
Country	:	US
Telephone Number	:	860-545-7828
Fax Number	:	860-545-7988

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

Provider Enumeration Date	:	03/28/2026
Last Update Date	:	03/30/2026

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