Healthcare Provider Details

I. General information

NPI: 1790561587
Provider Name (Legal Business Name): SHAUGHN RYAN NALEZINSKI DCLS, CC(NRCC)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST
CONCORD NH
03301-2598
US

IV. Provider business mailing address

647 BROCKWAY RD
HOPKINTON NH
03229-2014
US

V. Phone/Fax

Practice location:
  • Phone: 603-227-7000
  • Fax:
Mailing address:
  • Phone: 603-341-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246QB0000X
TaxonomyBlood Banking Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: