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Individual

SHANNON BLAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
631 QUAKER LN S, WEST HARTFORD, CT 06110-1026
(860) 233-5133
(860) 232-6527
Mailing address
229 HENRY ST, MANCHESTER, CT 06042-3243
(860) 371-5335

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001550
CT

Other

Enumeration date
06/21/2006
Last updated
07/28/2011
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