Individual
MS. SHANNON R PACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
305 WESTERN BLVD, GLASTONBURY, CT 06033-4380
(860) 522-0604
Mailing address
305 WESTERN BLVD, GLASTONBURY, CT 06033-4380
(860) 522-0604
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2946
CT
363AM0700X
Medical Physician Assistant
Primary
23.002946
CT
Other
Enumeration date
08/20/2013
Last updated
07/11/2023
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