Healthcare Provider Details

I. General information

NPI: 1790980746
Provider Name (Legal Business Name): JENNIFER M SHUART PMHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131B MAIN ST
EPPING NH
03042-2428
US

IV. Provider business mailing address

131 MAIN ST UNIT B
EPPING NH
03042-2405
US

V. Phone/Fax

Practice location:
  • Phone: 617-283-3305
  • Fax: 603-218-6990
Mailing address:
  • Phone: 617-283-3305
  • Fax: 603-218-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114969
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number078416-23
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number078416-23
License Number StateNH

VII. Legacy identifiers

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

# 1
Identifier110027964A
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer
# 2
Identifier3114987
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: