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General NPI Number Information
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NPI Number | 1568033371
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Entity Type | Organization
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Legal Business Name | SHANNON PSYCHIATRY
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Dates
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Enumeration Date | 07/02/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 6 LIBERTY SQUARE PMB 311
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City | BOSTON
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State | MA
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Zip | 02109
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Country | US
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Telephone | 617-858-1833
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Fax |
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Provider Business Mailing Address
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Address Line | 6 LIBERTY SQUARE PMB 311
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City | BOSTON
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State | MA
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Zip | 02109
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Country | US
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Telephone | 617-858-1833
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBIN SHANNON
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Credential | FNP, PMHNP
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Telephone | 617-858-1833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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