Healthcare Provider Details

I. General information

NPI: 1922585835
Provider Name (Legal Business Name): SHANNON TESS OLIVER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON TESS CONLEY CRNA

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 REEDSDALE RD
MILTON MA
02186-3926
US

IV. Provider business mailing address

144 GOULD ST STE 150
NEEDHAM MA
02494-2309
US

V. Phone/Fax

Practice location:
  • Phone: 617-696-4600
  • Fax:
Mailing address:
  • Phone: 339-204-9516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2322482
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2322482
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: