Provider Demographics
NPI:1174683718
Name:BYRNSIDE, SHANNON
Entity Type:Individual
Prefix:MISS
First Name:SHANNON
Middle Name:
Last Name:BYRNSIDE
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 1:530 BORDER ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2432
Mailing Address - Country:US
Mailing Address - Phone:617-569-6560
Mailing Address - Fax:
Practice Address - Street 1:530 BORDER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2432
Practice Address - Country:US
Practice Address - Phone:617-569-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker