Shannon Marie O'Loughlin

Primary specialty

AudiologistTaxonomy code 231H00000X

License

000612 Issued in CT

Practice address

Crec-Soundbridge
123 Progress Drive
Wethersfield, CT 06109-0610

Phone

(860) 529-4260

Fax

(860) 257-8500

NPI assigned

Apr 9, 2019

Last updated

Apr 9, 2019By the provider in NPPES

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

Other identifiers 1

Other names 1

• Shannon Wannagot Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554768000000",
    "number": "1336602226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CREC-SOUNDBRIDGE",
            "address_2": "123 PROGRESS DRIVE",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061092450",
            "telephone_number": "860-529-4260",
            "fax_number": "860-257-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CREC-SOUNDBRIDGE",
            "address_2": "123 PROGRESS DRIVE",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061090610",
            "telephone_number": "860-529-4260",
            "fax_number": "860-257-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'LOUGHLIN",
        "first_name": "SHANNON",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-09",
        "last_updated": "2019-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CT",
            "license": "000612",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "000612",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "WANNAGOT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Audiologist in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Audiologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.