Healthcare Provider Details

I. General information

NPI: 1093626111
Provider Name (Legal Business Name): SHARI GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BAY STATE RD
BOSTON MA
02215-1506
US

IV. Provider business mailing address

130 ARSENAL ST UNIT 1422
WATERTOWN MA
02472-2939
US

V. Phone/Fax

Practice location:
  • Phone: 617-353-3047
  • Fax:
Mailing address:
  • Phone: 973-477-2834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: