Provider Demographics
NPI:1417635939
Name:JOSHI, SHAWN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:JOSHI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 BEACON ST APT B2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1021
Mailing Address - Country:US
Mailing Address - Phone:703-898-8652
Mailing Address - Fax:
Practice Address - Street 1:478 BEACON ST APT B2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-1021
Practice Address - Country:US
Practice Address - Phone:703-898-8652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3014452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine