Individual
SHANNON DEE FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
51 PERFORMANCE DR, ENTRY 2, WEYMOUTH, MA 02189-3141
(781) 682-8000
(781) 335-1412
Mailing address
141 LONGWATER DR, NORWELL, MA 02061-1632
(781) 878-5200
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
205500
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042297845
UNITED HEALTH CARE
—
01
—
1821099110
NEIGHBORHOOD HEALTH PLAN
—
05
—
1821099110
—
MA
01
—
205500
TUFTS/TMP
—
01
—
7151128
AETNA
—
01
—
9034507
CIGNA
—
01
—
976196 08
NETWORK HEALTH
—
01
—
AA279482
HARVARD PILGRIM
—
01
—
SS0128
BCBSMA
—
Enumeration date
08/09/2005
Last updated
01/08/2014
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