Healthcare Provider Details

I. General information

NPI: 1003660150
Provider Name (Legal Business Name): SHAUN CHARLES SPANOS APRN, PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 ALBION ST STE 4B
WAKEFIELD MA
01880-2801
US

IV. Provider business mailing address

28 WINTER ST
BURLINGTON MA
01803-3271
US

V. Phone/Fax

Practice location:
  • Phone: 781-314-0002
  • Fax:
Mailing address:
  • Phone: 978-866-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN255779
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: