Provider Demographics
NPI:1598029084
Name:SHATTUCK, BRAD (DO)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:SHATTUCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOYLSTON ST.
Mailing Address - Street 2:16TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02199
Mailing Address - Country:US
Mailing Address - Phone:857-288-8342
Mailing Address - Fax:888-160-5204
Practice Address - Street 1:800 BOYLSTON ST.
Practice Address - Street 2:16TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02199
Practice Address - Country:US
Practice Address - Phone:857-288-8342
Practice Address - Fax:888-160-5204
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2528012084P0800X
MA2614802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry