Provider Demographics
NPI:1013015437
Name:SHOPNICK, BARRY A (PA-C)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:SHOPNICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-4008
Mailing Address - Country:US
Mailing Address - Phone:508-904-1057
Mailing Address - Fax:
Practice Address - Street 1:DIV CARDIAC SURGERY BRIGHAM AND WOMEN'S HOSPITAL
Practice Address - Street 2:75 FRANCIS ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-732-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MA128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant