MEDICARE: MS. SHOSHANA MARCHAND PMHNP-BC

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN283702	MA

General Provider Information

NPI Number	:	1336493949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHOSHANA MARCHAND PMHNP-BC

Provider Business Mailing Address
First Line	:	332 BIRNIE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1104
Country	:	US
Telephone Number	:	413-439-2260
Fax Number	:	413-439-2109

Provider Business Practice Location Address
First Line	:	179 NORTHAMPTON ST
Second Line	:
City	:	EASTHAMPTON
State	:	MA
Zip	:	01027-1057
Country	:	US
Telephone Number	:	413-439-2260
Fax Number	:	413-439-2109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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