MEDICARE: MARY SHUPE

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	163WP0200X	Pediatric Registered Nurse	231472	MA
2	163WP0200X	Pediatric Registered Nurse	062997-23	NH

General Provider Information

NPI Number	:	1487830295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SHUPE

Provider Business Mailing Address
First Line	:	58 HAWTHORNE DR
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6912
Country	:	US
Telephone Number	:	603-622-8619
Fax Number	:

Provider Business Practice Location Address
First Line	:	58 HAWTHORNE DR
Second Line	:
City	:	BEDFORD
State	:	NH
Zip	:	03110-6912
Country	:	US
Telephone Number	:	603-622-8619
Fax Number	:	603-640-1228

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/12/2026

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Directions to “ MARY SHUPE ” Practice Location

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