MEDICARE: SHANNON S DESIMONE APRN

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	363LF0000X	Family Nurse Practitioner	003221	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669456976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON S DESIMONE APRN

Provider Business Mailing Address
First Line	:	14 TANNERS DR
Second Line	:
City	:	WILTON
State	:	CT
Zip	:	06897-1117
Country	:	US
Telephone Number	:	203-423-9416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HOSPITAL PLZ
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06902-3602
Country	:	US
Telephone Number	:	203-423-9416
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/10/2019

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