Provider Demographics
NPI:1982202214
Name:DUPERRIER, SHALANDA
Entity Type:Individual
Prefix:
First Name:SHALANDA
Middle Name:
Last Name:DUPERRIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1731
Mailing Address - Country:US
Mailing Address - Phone:617-407-7690
Mailing Address - Fax:
Practice Address - Street 1:181 UNION ST # J
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1311
Practice Address - Country:US
Practice Address - Phone:781-244-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health