Healthcare Provider Details

I. General information

NPI: 1427732361
Provider Name (Legal Business Name): KATHERINE SHULMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 INDEPENDENCE AVE
QUINCY MA
02169-7751
US

IV. Provider business mailing address

191 INDEPENDENCE AVE
QUINCY MA
02169-7751
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-5070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT022887
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: