| NPI | 1508830548 |
|---|---|
| Former Name | SHANNON ANNE CONNOLLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 2341) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO 3118) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-03-21 |