Provider Demographics
NPI:1558880245
Name:SHULMAN, ALICIA (CNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 BROOKLINE PL STE 305
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7296
Mailing Address - Country:US
Mailing Address - Phone:617-732-1510
Mailing Address - Fax:617-732-0986
Practice Address - Street 1:1 BROOKLINE PL STE 305
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7296
Practice Address - Country:US
Practice Address - Phone:617-732-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273133363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health