Healthcare Provider Details

I. General information

NPI: 1215572359
Provider Name (Legal Business Name): SHAYNA AILEEN KORONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SOUTH ST
CHESTNUT HILL MA
02467-3658
US

IV. Provider business mailing address

50 E SQUANTUM ST APT 27A
QUINCY MA
02171-2278
US

V. Phone/Fax

Practice location:
  • Phone: 617-469-0300
  • Fax:
Mailing address:
  • Phone: 310-308-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2307383
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: