| Doctor Name: | SHANE P KINSEY |
| NPI Number: | 1225015795 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | 001450 |
| Business Practice Address: | 1260 Silas Deane Highway Wethersfield, CT - 06109 |
| Business Phone Number: | 8605291100 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1086, Hartford Medical Group WILBRAHAM |
| State: | MA |
| Postal Code: | 010951086 |
| Phone Number: | 5085950531 |
| Fax Number: | 5088295367 |
| NPI Enumeration Date: | 12/27/2005 |
| NPI Last Update Date: | 12/21/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 001450 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |