Healthcare Provider Details

I. General information

NPI: 1700560224
Provider Name (Legal Business Name): SHELLEY MARIE MILLIARD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MOOSEHEAD TRL
NEWPORT ME
04953-4055
US

IV. Provider business mailing address

118 MOOSEHEAD TRL
NEWPORT ME
04953-4055
US

V. Phone/Fax

Practice location:
  • Phone: 207-368-5189
  • Fax:
Mailing address:
  • Phone: 207-368-5189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP231286
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: