Healthcare Provider Details

I. General information

NPI: 1184725871
Provider Name (Legal Business Name): SHEILA ANN BOTTI RN CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MAIN ST
STURBRIDGE MA
01566
US

IV. Provider business mailing address

44 CEDAR ST
STURBRIDGE MA
01566
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-7755
  • Fax:
Mailing address:
  • Phone: 508-347-5638
  • Fax: 508-347-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number106900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: