Healthcare Provider Details

I. General information

NPI: 1033056866
Provider Name (Legal Business Name): SHANNON SURPIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON SURPIN FLETCHER RN

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 TRADEWINDS RD
OAK BLUFFS MA
02557-7278
US

IV. Provider business mailing address

PO BOX 846
OAK BLUFFS MA
02557-0846
US

V. Phone/Fax

Practice location:
  • Phone: 732-829-0059
  • Fax:
Mailing address:
  • Phone: 732-829-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2335015
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: