MEDICARE: DR. SHELLY C BERNSTEIN MD, PHD

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	208000000X	Pediatrics Physician	MA48174	MA
2	208000000X	Pediatrics Physician	48174	MA
3	2080P0207X	Pediatric Hematology & Oncology Physician	48174	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200316	OTHER	MA	HARVARD PILGRIM HEALTH PL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	048174	OTHER	MA	TUFTS HEALTH PLAN
4	BEJ07219	OTHER	MA	BCBS MASS

General Provider Information

NPI Number	:	1457395980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLY C BERNSTEIN MD, PHD

Provider Business Mailing Address
First Line	:	486 BOSTON POST ROAD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-1529
Country	:	US
Telephone Number	:	781-899-4456
Fax Number	:	781-647-9578

Provider Business Practice Location Address
First Line	:	486 BOSTON POST ROAD
Second Line	:
City	:	WESTON
State	:	MA
Zip	:	02493-1529
Country	:	US
Telephone Number	:	781-899-4456
Fax Number	:	781-647-9578

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	09/08/2015

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Directions to “ DR. SHELLY C BERNSTEIN MD, PHD” Practice Location

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