Healthcare Provider Details

I. General information

NPI: 1407572522
Provider Name (Legal Business Name): TANYA SHEPHERD WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE
BOSTON MA
02215-5400
US

IV. Provider business mailing address

13 RAINBOW CIR
PEABODY MA
01960-5745
US

V. Phone/Fax

Practice location:
  • Phone: 508-395-1110
  • Fax:
Mailing address:
  • Phone: 508-395-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN2292866
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN2292866
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: