Individual provider · Type 1 NPI
Shannen Moore
Pediatric Nurse Practitioner · Boston, MA
NPI number
1083092977
Active
Practice location
8 Waterman Rd
Boston, MA 02131-2218
Mailing address
10 Monroe Blvd Apt 6F
Long Beach, NY 11561-4355
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | 701502 (NY) |
| Certified Registered Nurse Anesthetist | 367500000X | 701502 (NY) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | 383018 (NY) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1083092977
Shannen Moore's National Provider Identifier is 1083092977, issued on May 11, 2015. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Boston, MA. The record was last updated on Jan 27, 2026.