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General NPI Number Information
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NPI Number | 1780399485
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Entity Type | Individual
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Provider Name | SHAYNE BOURQUE PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 300 MAIN ST
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City | NASHUA
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State | NH
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Zip | 03060-4635
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Country | US
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Telephone | 603-333-1471
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Fax | 603-255-7286
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Provider Business Mailing Address
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Address Line | 10 FERRY ST STE 302
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City | CONCORD
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State | NH
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Zip | 03301-5081
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Country | US
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Telephone | 603-333-1471
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Fax | 603-255-7286
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2822
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License Number State | NH
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