Healthcare Provider Details

I. General information

NPI: 1811071012
Provider Name (Legal Business Name): SHEILA M CALLAHAN BUTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 CHANDLER STREET
WORCESTER MA
01602
US

IV. Provider business mailing address

372 CHANDLER STREET
WORCESTER MA
01602
US

V. Phone/Fax

Practice location:
  • Phone: 508-767-3992
  • Fax: 508-767-3999
Mailing address:
  • Phone: 508-767-3992
  • Fax: 508-767-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53989
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: