Individual
MRS. SHANNON NICOLE FORLIVIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 BOSTON MEDICAL CTR PL # C500, BOSTON, MA 02118-2908
(617) 638-8609
(617) 638-8607
Mailing address
960 MASSACHUSETTS AVENUE, FL 2, BOSTON, MA 02118
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PS9068
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110192751A
—
MA
Enumeration date
09/22/2022
Last updated
09/15/2023
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