Healthcare Provider Details

I. General information

NPI: 1356067565
Provider Name (Legal Business Name): CHRISTIE MARIE SHEPHERD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMBRIDGE ST
BOSTON MA
02114-2509
US

IV. Provider business mailing address

100 CAMBRIDGE ST
BOSTON MA
02114-2509
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP22149
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN258812
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: