Provider Demographics
NPI:1023452968
Name:OTERI, SHANNON LEIGH (DO)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:OTERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEIGH
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 MILLBURY ST CHILD HEALTH ASSOCIATES
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-3205
Mailing Address - Country:US
Mailing Address - Phone:508-832-9691
Mailing Address - Fax:508-721-2070
Practice Address - Street 1:105 MILLBURY ST CHILD HEALTH ASSOCIATES
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-3205
Practice Address - Country:US
Practice Address - Phone:508-832-9691
Practice Address - Fax:508-721-2070
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program