Individual
THERESA L SHANAHAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 LYONS ST, DEDHAM, MA 02026-5599
(781) 329-1400
(781) 278-5667
Mailing address
PO BOX 9120, DEDHAM, MA 02027-9120
(781) 329-1400
(781) 278-5667
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
206175
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023152
NEIGHBORHOOD HEALTH
—
01
—
0141330
MASS HEALTH
—
01
—
1240820
UNITED HEALTHCARE
—
01
—
204130
HARVARD PILGRIM PPO
—
01
—
206175
TUFTS
—
01
—
27697
CHILDREN'S MED SECURITY
—
01
—
2780341
HEALTHSOURCE
MA
01
—
2780341
CIGNA HEALTH CARE
—
01
—
J23933
HMO BLUE/BLUE CHOICE
—
Enumeration date
07/07/2005
Last updated
07/08/2007
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