Basic Information
| Provider Information | |||||||||
| NPI: | 1669867412 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | THEODORE | ||||||||
| FirstName: | SHEINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 ALBANY STREET | ||||||||
| Address2: | FL GROUND | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02119 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 725 ALBANY STREET | ||||||||
| Address2: | SUITE 3A, SHAPIRO BUILDING | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174144861 | ||||||||
| FaxNumber: | 6174143617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 287724 | MA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 287724 | MA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.