Provider Demographics
NPI:1174139166
Name:PERRY, SHAYNA M (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:M
Last Name:PERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MASSACHUSETTS AVE STE 84
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3071
Mailing Address - Country:US
Mailing Address - Phone:617-354-4450
Mailing Address - Fax:617-354-4452
Practice Address - Street 1:875 MASSACHUSETTS AVE STE 84
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3071
Practice Address - Country:US
Practice Address - Phone:617-354-4450
Practice Address - Fax:617-354-4452
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical