Shannon Leigh Maxon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001221 Issued in CT

Practice address

33 Cosey Beach Ave
East Haven, CT 06512-4905

Phone

(413) 530-1813

Fax

(203) 867-5509

NPI assigned

Jan 23, 2007

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: smaxon100088@direct.ynhh.org

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.

• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236
  Medicare reassignment NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• Hospital of Saint Raphael

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1548269624
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456099200000",
    "number": "1407900566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 COSEY BEACH AVE",
            "city": "EAST HAVEN",
            "state": "CT",
            "postal_code": "06512",
            "telephone_number": "413-530-1813",
            "fax_number": "203-867-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 COSEY BEACH AVE",
            "city": "EAST HAVEN",
            "state": "CT",
            "postal_code": "065124905",
            "telephone_number": "413-530-1813",
            "fax_number": "203-867-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXON",
        "first_name": "SHANNON",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2016-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ralph Christopher Manna, DC
• Marc Glassman Inc (Xpect Pharmacy)
• Kimberly Rose Martin, MSPT
• Sonia Massey, LMSW
• Gisela I Matisons, COTA
• Matthew Mazzucco, PHARMD
• Rebecca Lynn McCarthy, PHARMD
• Cheyenne Ellise McElhiney, LMHC/P
• Elizabeth Anne McNeill
• Melissa Ripani, MFT, LLC

• Physician Assistant in East Haven, CT
• Providers in East Haven, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.