Shannon Marie McGourn, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F01241425 Issued in CT

Practice address

1279 W Main St
Waterbury, CT 06708-3101

Phone

(203) 755-5490

NPI assigned

Feb 6, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MC Diagnostic of Connecticut, P.C.Group PAC ID 0941382113, 66 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shannon.mcgourn.1@21238.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MC Diagnostic of Connecticut, P.C.

  • Family Nurse Practitioner
  • Rocky Hill, CT
  • NPI 1386821932
  Medicare reassignment Care Compare group
• Staywell Health Care, Inc.

  • Family Medicine Physician
  • Waterbury, CT
  • NPI 1154342335
  Medicare reassignment NPD
• Minuteclinic Primary Care Connecticut PLLC

  • Family Nurse Practitioner
  • Rocky Hill, CT
  • NPI 1548076086
  Medicare reassignment
• Northwest Hills Pediatrics PC

  • Pediatric Adolescent Medicine Physician
  • Torrington, CT
  • NPI 1639220676

  Family

  NPD (past)
• Staywell Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Naugatuck, CT
  • NPI 1982151635
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773187200000",
    "number": "1104680644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 OLD TURNPIKE RD",
            "city": "PLANTSVILLE",
            "state": "CT",
            "postal_code": "064791715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 W MAIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083101",
            "telephone_number": "203-755-5490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOURN",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-06",
        "last_updated": "2026-03-11",
        "certification_date": "2026-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "F01241425",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marvia Rosemarie McDonald-Dias
• Neysa J. McDonald
• Robert J McDonald, MD
• Deshawn McFarlane
• Fahmida Khan McGann, DO
• Kelsey McGregor, MS
• Geraldine McGuirk, APRN
• Amy Elizabeth McHugh, MSW
• Cathleen M. McInerney, LMFT
• Austin Robert George McIntosh, MD

• Family Nurse Practitioner in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.