Healthcare Provider Details

I. General information

NPI: 1942595228
Provider Name (Legal Business Name): SHAYNA COLLEEN RIVARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date: 02/25/2020
Reactivation Date: 03/20/2020

III. Provider practice location address

55 MILL ST
WOLFEBORO NH
03894-4328
US

IV. Provider business mailing address

526 MAIN ST STE 302
ACTON MA
01720-3301
US

V. Phone/Fax

Practice location:
  • Phone: 603-569-3376
  • Fax: 603-569-5046
Mailing address:
  • Phone: 978-371-7010
  • Fax: 978-371-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number22256
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22256
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: