MEDICARE: SHORE PINE PSYCHIATRY, PLLC

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

General Provider Information

NPI Number	:	1962360529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE PINE PSYCHIATRY, PLLC

Provider Business Mailing Address
First Line	:	35 SOUTH ST UNIT 1
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 SOUTH ST UNIT 1
Second Line	:
City	:	JAMAICA PLAIN
State	:	MA
Zip	:	02130-3112
Country	:	US
Telephone Number	:	774-239-8445
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MRS. MELISSA KAELI
Credential	:	PMHNP
Telephone Number	:	774-239-8445

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	01/13/2026

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