Provider Demographics
NPI:1801848106
Name:SHAMEL, SUSAN ALICE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALICE
Last Name:SHAMEL
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 1:20 PONDMEADOW DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3218
Mailing Address - Country:US
Mailing Address - Phone:781-944-6564
Mailing Address - Fax:781-944-4764
Practice Address - Street 1:20 PONDMEADOW DR
Practice Address - Street 2:SUITE 108
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3218
Practice Address - Country:US
Practice Address - Phone:781-944-6564
Practice Address - Fax:781-944-4764
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66494OtherBLUE CROSS BLUE SHIELD
MA0034118OtherNEIGHBORHOOD HEALTH PLAN
MA468832OtherTUFTS
MA468832OtherTUFTS