Shattuck, Marney Blake

Shattuck, Marney Blake is an individual health care provider with primary practice located at 139 Turnpike Rd , Westborough MA 01581-2835. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Shattuck, Marney Blake can be contacted via phone (508) 882-7300.

Contact Information

Primary practice address
139 Turnpike Rd Westborough MA 01581-2835
Phone: (508) 882-7300
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA8569 Massachusetts
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA8569 Massachusetts

Profile Details

NPI number 1568059004
LBN Legal business name Shattuck, Marney Blake
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 30th, 2020
Last updated May 14th, 2024 - about 4 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568059004 NPPES
Massachusetts MEDICAID 110183157A

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