Healthcare Provider Details

I. General information

NPI: 1174454151
Provider Name (Legal Business Name): JORDYN SHIPOTOFSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NORTHWEST BLVD
NASHUA NH
03063-4068
US

IV. Provider business mailing address

32 KESSLER FARM DR APT 506
NASHUA NH
03063-7142
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-5721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number085455-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: