Provider Demographics
NPI:1295889913
Name:BAZES, SHELLY V (NP)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:V
Last Name:BAZES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SHELLY
Other - Middle Name:VIVIAN
Other - Last Name:BAZES-BARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:824 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2508
Practice Address - Country:US
Practice Address - Phone:617-732-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP4989OtherBCBS
MANP4989OtherBCBS