Individual
DR. JENNIFER MARIE SHANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
63 RANGE RD, SUITE 104, WINDHAM, NH 03087-2098
(603) 893-1500
(603) 952-4981
Mailing address
30 BIRCH ST, # 1, DERRY, NH 03038-2120
(603) 247-3291
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0766
NH
152W00000X
Optometrist
4565
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30353272
—
NH
Enumeration date
08/14/2006
Last updated
07/21/2009
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