Healthcare Provider Details

I. General information

NPI: 1437445038
Provider Name (Legal Business Name): SHANNON MELISSA BRANCIERI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BIRCH ST
DERRY NH
03038-2136
US

IV. Provider business mailing address

784 HERCULES DR STE 110
COLCHESTER VT
05446-8049
US

V. Phone/Fax

Practice location:
  • Phone: 603-635-2802
  • Fax: 603-635-3070
Mailing address:
  • Phone: 802-448-9787
  • Fax: 802-448-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRM2304686
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number336834
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number072588-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: