Provider Demographics
NPI:1144759648
Name:SHOREY, JENICA
Entity Type:Individual
Prefix:
First Name:JENICA
Middle Name:
Last Name:SHOREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HIGH ROCK RD
Mailing Address - Street 2:
Mailing Address - City:N ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 HIGH ROCK RD
Practice Address - Street 2:
Practice Address - City:N ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-3517
Practice Address - Country:US
Practice Address - Phone:774-254-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program