| Doctor Name: | SHANNON C BERGER |
| NPI Number: | 1043528045 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 002456 |
| Business Practice Address: | 1260 Silas Deane Hwy Wethersfield, CT - 061094362 |
| Business Phone Number: | 8602583470 |
| Business Fax Number: | 8605716800 |
| Mailing Address: | 2110 Silas Deane Hwy, ROCKY HILL |
| State: | CT |
| Postal Code: | 060672313 |
| Phone Number: | 8602583470 |
| Fax Number: | 8605716801 |
| NPI Enumeration Date: | 09/24/2010 |
| NPI Last Update Date: | 10/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 002456 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |