Healthcare Provider Details

I. General information

NPI: 1063059467
Provider Name (Legal Business Name): SHEVONNE RENEE LINNANE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHEVONNE RENEE BAINES

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

619 ADAMS ST APT 1
BOSTON MA
02122-2569
US

V. Phone/Fax

Practice location:
  • Phone: 857-218-3046
  • Fax: 617-730-0201
Mailing address:
  • Phone: 703-628-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019047493
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: