Provider Demographics
NPI:1558688556
Name:COPPINGER, SHAUNA
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:COPPINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:HUBISZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 ENON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1106
Mailing Address - Country:US
Mailing Address - Phone:978-921-1144
Mailing Address - Fax:
Practice Address - Street 1:45 ENON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1106
Practice Address - Country:US
Practice Address - Phone:978-921-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7353225700000X
MAPA7978363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist