Healthcare Provider Details

I. General information

NPI: 1518876085
Provider Name (Legal Business Name): SHAUN MATTOON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

V. Phone/Fax

Practice location:
  • Phone: 413-344-6110
  • Fax:
Mailing address:
  • Phone: 413-447-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberRN2303612
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: