MEDICARE: THE ELLIOT LEWIS CENTER FOR MULTIPLE SCLEROSIS CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1306210422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ELLIOT LEWIS CENTER FOR MULTIPLE SCLEROSIS CARE LLC

Provider Business Mailing Address
First Line	:	110 CEDAR ST STE 110
Second Line	:
City	:	WELLESLEY
State	:	MA
Zip	:	02481-3527
Country	:	US
Telephone Number	:	781-591-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 CEDAR ST
Second Line	:	SUITE 110
City	:	WELLESLEY
State	:	MA
Zip	:	02481-3527
Country	:	US
Telephone Number	:	781-591-8300
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARISSA SHACKLETON
Credential	:
Telephone Number	:	781-591-8300

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	01/05/2026

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