Healthcare Provider Details

I. General information

NPI: 1043715543
Provider Name (Legal Business Name): CRISTINA A SHEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

300 1ST AVE
CHARLESTOWN MA
02129-3109
US

V. Phone/Fax

Practice location:
  • Phone: 617-952-5299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number1014280
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1014280
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: