Provider Demographics
NPI:1407521834
Name:COSTA, SHAWN MICHAEL I
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MICHAEL
Last Name:COSTA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-4005
Mailing Address - Country:US
Mailing Address - Phone:978-875-1431
Mailing Address - Fax:
Practice Address - Street 1:308 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2511
Practice Address - Country:US
Practice Address - Phone:508-478-0555
Practice Address - Fax:508-473-5088
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant