Shane Preston, NP

Primary specialty

Occupational Health Nurse PractitionerTaxonomy code 363LX0106X

License

RN2324877 Issued in MA

Practice address

100 Brooksby Village Dr
Peabody, MA 01960-1438

Phone

(978) 536-7870

Fax

(978) 536-7997

NPI assigned

Mar 7, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1646611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1548917875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "336 HIGHLAND AVE",
            "city": "MALDEN",
            "state": "MA",
            "postal_code": "021485418",
            "telephone_number": "781-605-8158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BROOKSBY VILLAGE DR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601438",
            "telephone_number": "978-536-7870",
            "fax_number": "978-536-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTON",
        "first_name": "SHANE",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-07",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0106X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Occupational Health",
            "state": "MA",
            "license": "RN2324877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Health Nurse Practitioner in Peabody, MA
• Providers in Peabody, MA by specialty
• Occupational Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.