Healthcare Provider Details

I. General information

NPI: 1457546657
Provider Name (Legal Business Name): M. SHEILA PRENDEVILLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 COURT ST STE 1
PLYMOUTH MA
02360-8710
US

IV. Provider business mailing address

116 COURT ST STE 1
PLYMOUTH MA
02360-8710
US

V. Phone/Fax

Practice location:
  • Phone: 87-471-3185
  • Fax: 508-747-1410
Mailing address:
  • Phone: 508-477-1318
  • Fax: 508-747-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number260795
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMP06906831
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: