Provider Demographics
NPI:1003660150
Name:SPANOS, SHAUN CHARLES (APRN, PMHNP)
Entity Type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:CHARLES
Last Name:SPANOS
Suffix:
Gender:M
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3271
Mailing Address - Country:US
Mailing Address - Phone:978-866-8211
Mailing Address - Fax:
Practice Address - Street 1:29 ALBION ST STE 4B
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2801
Practice Address - Country:US
Practice Address - Phone:781-314-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255779363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health