Provider Demographics
NPI:1457395980
Name:BERNSTEIN, SHELLY C (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:C
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 BOSTON POST ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1529
Mailing Address - Country:US
Mailing Address - Phone:781-899-4456
Mailing Address - Fax:781-647-9578
Practice Address - Street 1:486 BOSTON POST ROAD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1529
Practice Address - Country:US
Practice Address - Phone:781-899-4456
Practice Address - Fax:781-647-9578
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA48174208000000X
MA48174208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA200316OtherHARVARD PILGRIM HEALTH PL
MA3012671Medicaid
MA048174OtherTUFTS HEALTH PLAN
MABEJ07219OtherBCBS MASS
MA048174OtherTUFTS HEALTH PLAN