| Doctor Name: | MR. SHAWN ROBERT PUTNAM |
| NPI Number: | 1033150719 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 257127 |
| Business Practice Address: | 440 New Britain Ave Plainville, CT - 060622036 |
| Business Phone Number: | 8607930500 |
| Business Fax Number: | 8607931116 |
| Mailing Address: | 1801 Asylum Ave, WEST HARTFORD |
| State: | CT |
| Postal Code: | 061172602 |
| Phone Number: | 8607930500 |
| Fax Number: | 8607931116 |
| NPI Enumeration Date: | 06/10/2006 |
| NPI Last Update Date: | 01/29/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 257127 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |