Healthcare Provider Details

I. General information

NPI: 1982621975
Provider Name (Legal Business Name): BIANCA S SHAGRIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WINDSOR ST
CAMBRIDGE MA
02139-3647
US

IV. Provider business mailing address

119 WINDSOR ST
CAMBRIDGE MA
02139-3647
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1660
  • Fax:
Mailing address:
  • Phone: 617-665-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number234899
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: