Healthcare Provider Details

I. General information

NPI: 1699407296
Provider Name (Legal Business Name): ABIGAIL SHAYEVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 BEACON ST STE 6B
BROOKLINE MA
02446-3806
US

IV. Provider business mailing address

7 DEAN RD
ASHLAND MA
01721-1757
US

V. Phone/Fax

Practice location:
  • Phone: 781-770-4064
  • Fax:
Mailing address:
  • Phone: 617-888-4106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2307147
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2307147
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: