Provider Demographics
NPI:1679818686
Name:CAMP, KERRY SHANLEY (PA)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:SHANLEY
Last Name:CAMP
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:243 CHARLES ST
Mailing Address - Street 2:FACIAL PLASTIC & RECONSTRUCTIVE SURGERY CENTER MEEI
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-4419
Mailing Address - Fax:
Practice Address - Street 1:243 CHARLES ST
Practice Address - Street 2:FACIAL PLASTIC & RECONSTRUCTIVE SURGERY CENTER MEEI
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-4419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-02
Last Update Date:2020-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant