Individual
SHANNON F.R. SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 443-3147
(860) 865-2395
Mailing address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 443-3147
(860) 865-2395
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
0101249001
VA
2086S0102X
Surgical Critical Care Physician
036143686
IL
2086S0102X
Surgical Critical Care Physician
Primary
79645
CT
Other
Enumeration date
06/20/2008
Last updated
11/11/2024
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