Healthcare Provider Details

I. General information

NPI: 1285551978
Provider Name (Legal Business Name): SHANE NATALWALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 REVOLUTION DRIVE MASS GENERAL BRIGHAM
SOMERVILLE MA
02145
US

IV. Provider business mailing address

399 REVOLUTION DRIVE MASS GENERAL BRIGHAM
SOMERVILLE MA
02145
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: