Provider Demographics
NPI:1528446192
Name:SHAMEKLIS, JACLYN (MD)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:SHAMEKLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MGH DIVISION OF PALLIATIVE CARE & GERIATRIC MEDICINE
Mailing Address - Street 2:55 FRUIT STREET, FOUNDERS 600
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-724-9509
Mailing Address - Fax:
Practice Address - Street 1:MGH DIVISION OF PALLIATIVE CARE & GERIATRIC MEDICINE
Practice Address - Street 2:55 FRUIT STREET, FOUNDERS 600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP03331207R00000X
RIMD16174207R00000X
MAET90070207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine