Provider Demographics
NPI:1285269431
Name:RAFFERTY, SHAUNA (NP-C)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 EXETER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1212
Mailing Address - Country:US
Mailing Address - Phone:203-560-1506
Mailing Address - Fax:
Practice Address - Street 1:836 FARMINGTON AVE STE 207
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1544
Practice Address - Country:US
Practice Address - Phone:860-232-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily