Healthcare Provider Details

I. General information

NPI: 1134956477
Provider Name (Legal Business Name): SHAWNA SCERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LINCOLN ST STE 203
WORCESTER MA
01605-3646
US

IV. Provider business mailing address

158 LANCASTER ST
LEOMINSTER MA
01453-4378
US

V. Phone/Fax

Practice location:
  • Phone: 508-856-0200
  • Fax: 508-856-0200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2307254
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: