Provider Demographics
NPI:1861773103
Name:TERRIO, SHANNON L (NP)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:L
Last Name:TERRIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LONGWOOD AVE FL 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5711
Mailing Address - Country:US
Mailing Address - Phone:617-355-8136
Mailing Address - Fax:617-730-0194
Practice Address - Street 1:333 LONGWOOD AVE FL 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5711
Practice Address - Country:US
Practice Address - Phone:617-355-8136
Practice Address - Fax:617-730-0194
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264131363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
042297845OtherMULTI-PLAN
MASS0116OtherBCBSMA
MA110091592AMedicaid
1861773103OtherFALLON
042297845OtherTRICARE
MASS0116OtherBCBSMA