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NPI Code Detail

MEDICARE: SHIRLEY CHAN PA-C

MEDICARE: SHIRLEY CHAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA2049MA

General Provider Information

NPI Number : 1326224668
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHIRLEY CHAN PA-C
Provider Business Mailing Address
First Line : 321 WALNUT ST # 221
Second Line :
City : NEWTON
State : MA
Zip : 02460-1927
Country : US
Telephone Number : 617-359-8887
Fax Number :
Provider Business Practice Location Address
First Line : 1094 WORCESTER RD
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01702-5255
Country : US
Telephone Number : 508-879-2550
Fax Number : 508-820-9844
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2008
Last Update Date : 04/09/2013

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Directions to “ SHIRLEY CHAN PA-C” Practice Location

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