Healthcare Provider Details

I. General information

NPI: 1528265659
Provider Name (Legal Business Name): TIMOTHY SHIVELEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 LINCOLN ST MED STAFF SVCS
WORCESTER MA
01605-2138
US

IV. Provider business mailing address

281 LINCOLN ST MED STAFF SVCS
WORCESTER MA
01605-2138
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-8015
  • Fax:
Mailing address:
  • Phone: 508-334-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number34C.000807
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34086
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberOS21824
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number233412
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS21824
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberC2499
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberV7785
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: