Active NPI
Shannon Cleary
- Pediatrics Physician
- Boston, MA
National Provider Identifier
1760123723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 1026924
- Practice address
- 55 Fruit St
Boston, MA 02114-2621 - Phone
- (617) 726-7782
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 1026924 | MA | Primary |
| Internal Medicine Physician | 207R00000X | 1026924 | MA |
Addresses
Primary practice location
55 Fruit St
Boston, MA 02114-2621
Mailing address
175 Cambridge St FL 5
Boston, MA 02114-2743
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260605003671 | MA | Practitioner - Internal Medicine | 0547641995 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1026924 | MA | MD | Internal Medicine Physician |
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Rochester School of Medicine and Dentistry, 2022
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
399 Revolution Dr
Suite 458
Somerville, MA 02145-1444
399 Revolution Dr
Suite 458
Somerville, MA 02145-1488
55 Fruit St
Boston, MA 02114-2621
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1779926400000",
"number": "1760123723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "175 CAMBRIDGE ST FL 5",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 FRUIT ST",
"city": "BOSTON",
"state": "MA",
"postal_code": "021142621",
"telephone_number": "617-726-7782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLEARY",
"first_name": "SHANNON",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-04-05",
"last_updated": "2026-05-28",
"certification_date": "2026-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "1026924",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "1026924",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.