Provider Demographics
NPI:1568711760
Name:BREAUX, MANDY SHENYIN (RN, NP)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:SHENYIN
Last Name:BREAUX
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:SHENYIN
Other - Middle Name:
Other - Last Name:HUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2431
Mailing Address - Country:US
Mailing Address - Phone:617-318-3250
Mailing Address - Fax:617-457-6600
Practice Address - Street 1:88 HOLMES ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2431
Practice Address - Country:US
Practice Address - Phone:617-317-3250
Practice Address - Fax:617-457-6600
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274688163W00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008042209Medicaid
CTD400081435Medicare PIN