Provider Demographics
NPI:1275334922
Name:JACKSON-CONNOR, SHADDAE GENEVA
Entity type:Individual
Prefix:MRS
First Name:SHADDAE
Middle Name:GENEVA
Last Name:JACKSON-CONNOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 MORNING DOVE RD
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4807
Mailing Address - Country:US
Mailing Address - Phone:929-620-3503
Mailing Address - Fax:
Practice Address - Street 1:1000 BRIDGEPORT AVE STE 405
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4660
Practice Address - Country:US
Practice Address - Phone:203-993-6592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1291732103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst