Individual
KELLEY B SHANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1073 N BENSON RD, FAIRFIELD, CT 06824-5171
(206) 254-4000
(203) 254-4263
Mailing address
1073 N BENSON RD, FAIRFIELD, CT 06824-5171
(203) 254-4000
(203) 254-4263
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024173923
VA
363LF0000X
Family Nurse Practitioner
Primary
16004
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06734
GROUP PTAN
VA
01
—
C06778
GROUP PTAN
VA
01
—
C09633
GROUP PTAN
VA
Enumeration date
09/09/2016
Last updated
02/10/2026
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