Provider Demographics
NPI:1457651333
Name:HANLEY, NIKITA SHAH (NP)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:SHAH
Last Name:HANLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE
Mailing Address - Street 2:STONEMAN 10
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5400
Mailing Address - Country:US
Mailing Address - Phone:617-667-3940
Mailing Address - Fax:617-667-2155
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:ORTHOPAEDICS - STONEMAN 10
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-3940
Practice Address - Fax:617-667-2155
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN280019363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health