Healthcare Provider Details

I. General information

NPI: 1578823274
Provider Name (Legal Business Name): CHRISTINE SHERIDAN SHUSTERMAN MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE PAIN TREATMENT OFFICE 5TH FLOOR
BOSTON MA
02115-5711
US

IV. Provider business mailing address

28 BLACKSMITH DR
NEEDHAM MA
02492-1902
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6995
  • Fax: 617-730-0649
Mailing address:
  • Phone: 781-400-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN241182
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: