Healthcare Provider Details

I. General information

NPI: 1497274476
Provider Name (Legal Business Name): SHELBY ANN BARDEN MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 HALE ST
BEVERLY MA
01915-2098
US

IV. Provider business mailing address

151 UPPER JAFFREY RD
DUBLIN NH
03444-8645
US

V. Phone/Fax

Practice location:
  • Phone: 603-933-0397
  • Fax:
Mailing address:
  • Phone: 603-933-0397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: