Healthcare Provider Details

I. General information

NPI: 1700141793
Provider Name (Legal Business Name): SHAY ERISSON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST STE 768
NEWTON MA
02462-1645
US

IV. Provider business mailing address

2000 WASHINGTON ST STE 768
NEWTON MA
02462-1645
US

V. Phone/Fax

Practice location:
  • Phone: 617-332-2345
  • Fax: 617-332-2345
Mailing address:
  • Phone: 617-332-2345
  • Fax: 617-332-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number276278
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: