Healthcare Provider Details

I. General information

NPI: 1114536463
Provider Name (Legal Business Name): SHANNON BECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 AUTUMN RD
MEDWAY MA
02053-2153
US

IV. Provider business mailing address

7 AUTUMN RD
MEDWAY MA
02053-2153
US

V. Phone/Fax

Practice location:
  • Phone: 508-397-3486
  • Fax:
Mailing address:
  • Phone: 508-397-3486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN274440
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: