Healthcare Provider Details

I. General information

NPI: 1295540797
Provider Name (Legal Business Name): ABIGAIL SHAUGHNESSY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PARKMAN ST # 835
BOSTON MA
02114-3117
US

IV. Provider business mailing address

88 SARGENT ST
WINTHROP MA
02152-2806
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8281
  • Fax:
Mailing address:
  • Phone: 781-570-9721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN2267761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: