Provider Demographics
NPI:1801854849
Name:GILLIES, SHIRLEY (NP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:GILLIES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 517
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-868-0847
Mailing Address - Fax:617-491-6048
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 517
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-868-0847
Practice Address - Fax:617-491-6048
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA175285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0385590Medicaid
MANP2228Medicare ID - Type Unspecified
MAS99732Medicare UPIN