Provider Demographics
NPI:1881349462
Name:SHABAREKH, CASSANDRA KAITLYN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:KAITLYN
Last Name:SHABAREKH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2989
Mailing Address - Country:US
Mailing Address - Phone:978-473-1747
Mailing Address - Fax:
Practice Address - Street 1:17 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2989
Practice Address - Country:US
Practice Address - Phone:978-473-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2345651163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse