Provider Demographics
NPI:1700141793
Name:ERISSON, SHAY (MD)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:
Last Name:ERISSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST STE 768
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1645
Mailing Address - Country:US
Mailing Address - Phone:617-332-2345
Mailing Address - Fax:617-332-2345
Practice Address - Street 1:2000 WASHINGTON ST STE 768
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1645
Practice Address - Country:US
Practice Address - Phone:617-332-2345
Practice Address - Fax:617-332-2345
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276278207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology