Provider Demographics
NPI:1831599786
Name:RAZVILLAS, SHANA (FNP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:RAZVILLAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OLD SOMERSET AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-1824
Mailing Address - Country:US
Mailing Address - Phone:508-824-7557
Mailing Address - Fax:
Practice Address - Street 1:600 OLD SOMERSET AVE
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764-1824
Practice Address - Country:US
Practice Address - Phone:508-824-7557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN269648363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily