Individual
MARNEY BLAKE SHATTUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
139 TURNPIKE RD, WESTBOROUGH, MA 01581-2835
(508) 882-7300
Mailing address
360 US HIGHWAY 1 BYP UNIT 102, PORTSMOUTH, NH 03801-7105
(603) 410-6700
(603) 319-8308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA8569
MA
363AM0700X
Medical Physician Assistant
Primary
PA8569
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110183157A
—
MA
Enumeration date
12/30/2020
Last updated
05/14/2024
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