Healthcare Provider Details

I. General information

NPI: 1093587164
Provider Name (Legal Business Name): SHANNA LEAH CIPRO PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NAMSKAKET RD UNIT 1
ORLEANS MA
02653-3202
US

IV. Provider business mailing address

6 NAMSKAKET ROAD
ORLEANS MA
02653-4826
US

V. Phone/Fax

Practice location:
  • Phone: 774-332-3791
  • Fax: 774-207-5525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2266495
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: