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General NPI Number Information
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NPI Number | 1992348650
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Entity Type | Individual
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Provider Name | CHERYL SHAO
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Gender | Female
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Dates
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Enumeration Date | 10/24/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 85 RIVER ST STE 2
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City | WALTHAM
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State | MA
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Zip | 02453-8349
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Country | US
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Telephone | 781-891-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 85 RIVER ST
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City | WALTHAM
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State | MA
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Zip | 02453-8300
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1858526
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License Number State | MA
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