Individual
SHANNA M GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2200 WHITNEY AVE STE 270, HAMDEN, CT 06518-3694
(203) 281-7000
Mailing address
2200 WHITNEY AVE STE 270, HAMDEN, CT 06518-3694
(203) 281-7000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2318
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003023181
—
CT
Enumeration date
09/21/2009
Last updated
02/14/2022
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