Individual
SHANNON THEBADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
231 MAIN ST FL 3, BROCKTON, MA 02301-4342
(508) 586-2660
Mailing address
315 CANTON ST, STOUGHTON, MA 02072-2205
(617) 702-6947
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2330456
MA
Other
Enumeration date
01/30/2025
Last updated
01/30/2025
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