Healthcare Provider Details

I. General information

NPI: 1457651333
Provider Name (Legal Business Name): NIKITA SHAH HANLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKITA SHAH

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE ORTHOPAEDICS - STONEMAN 10
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE STONEMAN 10
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-3940
  • Fax: 617-667-2155
Mailing address:
  • Phone: 617-667-3940
  • Fax: 617-667-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN280019
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: