Individual
MR. CHRISTOPHER JOSEPH SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
17 PRINCE STREET, UNIT 2, JAMAICA PLAIN, MA 02130
(857) 928-6195
Mailing address
17 PRINCE ST, UNIT 2, JAMAICA PLAIN, MA 02130-2725
(857) 928-6195
Taxonomy
Speciality
Code
Description
License number
State
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
Primary
—
—
282N00000X
General Acute Care Hospital
205807
MA
363L00000X
Nurse Practitioner
205807
MA
363LA2200X
Adult Health Nurse Practitioner
205807
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316080195
—
RI
Enumeration date
02/14/2007
Last updated
09/07/2012
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