Healthcare Provider Details

I. General information

NPI: 1154057024
Provider Name (Legal Business Name): SHAUNA SHAW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NEWBURY ST
DANVERS MA
01923-1027
US

IV. Provider business mailing address

311 NEWBURY ST
DANVERS MA
01923-1027
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-5504
  • Fax:
Mailing address:
  • Phone: 617-694-7409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2339552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: