Healthcare Provider Details

I. General information

NPI: 1174436307
Provider Name (Legal Business Name): SHANNON RYAN GALLAGHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST
BROOKLINE MA
02446-3885
US

IV. Provider business mailing address

57 L ST APT 10
BOSTON MA
02127-1689
US

V. Phone/Fax

Practice location:
  • Phone: 508-979-5557
  • Fax:
Mailing address:
  • Phone: 781-715-3967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberRN10024494
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: