Individual
SHANNON B. BEAUSOLEIL I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1216 FARMINGTON AVE STE 202, WEST HARTFORD, CT 06107-2673
(860) 236-0331
(860) 263-8697
Mailing address
1216 FARMINGTON AVE STE 202, WEST HARTFORD, CT 06107-2673
(860) 236-0331
(860) 263-8697
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
043733
CT
208000000X
Pediatrics Physician
Primary
043733
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1302469
—
MA
01
—
218498
CONNECTICARE
MA
01
—
3352025
AETNA
MA
Enumeration date
11/02/2005
Last updated
06/22/2021
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