Healthcare Provider Details

I. General information

NPI: 1669692661
Provider Name (Legal Business Name): SHAN MARIE STOFFOLANO M.S., C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 LOOMIS ST
BEDFORD MA
01730-2248
US

IV. Provider business mailing address

62 PARK ST
PEPPERELL MA
01463-1117
US

V. Phone/Fax

Practice location:
  • Phone: 781-674-2900
  • Fax:
Mailing address:
  • Phone: 978-433-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number235651-NP
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number235651-NP
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: