Healthcare Provider Details

I. General information

NPI: 1710369863
Provider Name (Legal Business Name): DANIELLE A SHANLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MARKET ST FL 2
LYNNFIELD MA
01940-4048
US

IV. Provider business mailing address

480 MAPLE ST
DANVERS MA
01923-4065
US

V. Phone/Fax

Practice location:
  • Phone: 781-213-4040
  • Fax:
Mailing address:
  • Phone: 978-304-8380
  • Fax: 978-304-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number264751
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number273530
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: