Healthcare Provider Details

I. General information

NPI: 1740625565
Provider Name (Legal Business Name): SHEVAUGHN M KEALY M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 MUNSON ST
GREENFIELD MA
01301-9694
US

IV. Provider business mailing address

VETERANS AFFAIRS MEDICAL CENTER 421 NORTH MAIN STREET
LEEDS MA
01053-9764
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-8428
  • Fax: 413-582-3164
Mailing address:
  • Phone: 413-584-4040
  • Fax: 413-582-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number261914
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: