Shannon Blake, PA
NPI #1578509238 in West Hartford, Connecticut
Provider Information
- NPI Number
- 1578509238
- Entity Type
- Individual
- Name
- Shannon Blake, PA
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Physician Assistant
- Credential
- PA
- Enumeration Date
- Jun 21, 2006
- Last Updated
- Jul 28, 2011
Practice Location
- Address
- 631 QUAKER LN S
- City
- West Hartford
- State
- Connecticut
- ZIP Code
- 06110-1026
- Phone
- (860) 233-5133
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant |
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