Healthcare Provider Details

I. General information

NPI: 1205004793
Provider Name (Legal Business Name): JENNIFER SHARK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2008
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CARLETON ST
CAMBRIDGE MA
02142-1323
US

IV. Provider business mailing address

25 CARLETON ST
CAMBRIDGE MA
02142-1323
US

V. Phone/Fax

Practice location:
  • Phone: 617-253-1315
  • Fax: 617-258-0454
Mailing address:
  • Phone: 617-253-1315
  • Fax: 617-258-0454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN2276775
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: