Individual
MS. SHAUNTELLE MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1575 BLUE HILL AVE, MATTAPAN, MA 02126-2122
(617) 296-0061
(617) 296-5408
Mailing address
1575 BLUE HILL AVE, MATTAPAN, MA 02126-2122
(617) 296-0061
(617) 296-5408
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2278372
MA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2278372
MA
Other
Enumeration date
11/19/2013
Last updated
08/25/2022
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