Healthcare Provider Details

I. General information

NPI: 1174524524
Provider Name (Legal Business Name): DENISE R SHIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE R EBERSON MD

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/15/2026
Certification Date: 10/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 PINE ST STE 103
NORFOLK MA
02056-1680
US

IV. Provider business mailing address

1350 MAIN ST
WALPOLE MA
02081-1718
US

V. Phone/Fax

Practice location:
  • Phone: 508-668-2200
  • Fax: 508-668-6539
Mailing address:
  • Phone: 508-668-2200
  • Fax: 508-668-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number156761
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: