Healthcare Provider Details

I. General information

NPI: 1346018777
Provider Name (Legal Business Name): SHAYNA B CAMIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 ORLEANS ST UNIT 105
BOSTON MA
02128-2175
US

IV. Provider business mailing address

150 ORLEANS ST UNIT 105
BOSTON MA
02128-2175
US

V. Phone/Fax

Practice location:
  • Phone: 617-455-1196
  • Fax:
Mailing address:
  • Phone: 617-455-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: