Provider Demographics
NPI:1861478968
Name:STENEHJEM, SHANE D
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:D
Last Name:STENEHJEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUMMER STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-1914
Mailing Address - Country:US
Mailing Address - Phone:508-528-2525
Mailing Address - Fax:508-520-8901
Practice Address - Street 1:9 SUMMER STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038-1914
Practice Address - Country:US
Practice Address - Phone:508-528-2525
Practice Address - Fax:508-520-8901
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2204213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY71124OtherBC/BS
MA494209OtherTUFTS HEALTH PLAN
MAAA43714OtherHARVARD PILGRIM
MA27-01097OtherEVERCARE
MA7429718OtherAETNA
Y75120Medicare ID - Type Unspecified
U99966Medicare ID - Type Unspecified