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NPI Code Detail

MEDICARE: MS. SHANNON R PACKER PA-C

MEDICARE: MS. SHANNON R PACKER 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
1363A00000XPhysician Assistant2946CT
2363AM0700XMedical Physician Assistant23.002946CT

General Provider Information

NPI Number : 1861825259
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANNON R PACKER PA-C
Provider Business Mailing Address
First Line : 305 WESTERN BLVD
Second Line :
City : GLASTONBURY
State : CT
Zip : 06033-4380
Country : US
Telephone Number : 860-522-0604
Fax Number :
Provider Business Practice Location Address
First Line : 305 WESTERN BLVD
Second Line :
City : GLASTONBURY
State : CT
Zip : 06033-4380
Country : US
Telephone Number : 860-522-0604
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2013
Last Update Date : 07/11/2023

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Directions to “ MS. SHANNON R PACKER PA-C” Practice Location

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