Provider Demographics
NPI:1265166235
Name:MORGAN, SHANNON L (PMHNP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MASSACHUSETTS AVE STE 272
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3180
Mailing Address - Country:US
Mailing Address - Phone:774-473-2272
Mailing Address - Fax:620-202-7555
Practice Address - Street 1:955 MASSACHUSETTS AVE STE 272
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3180
Practice Address - Country:US
Practice Address - Phone:774-473-2272
Practice Address - Fax:620-202-7555
Is Sole Proprietor?:No
Enumeration Date:2022-07-14
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2273634363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110196652AMedicaid