Healthcare Provider Details

I. General information

NPI: 1861413403
Provider Name (Legal Business Name): HARRIOTT MEYER SHEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 GRANGER RD STE 1 ASSOCIATES IN PEDIATRICS - BERLIN
BERLIN VT
05602-0000
US

IV. Provider business mailing address

PO BOX 547 CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
BARRE VT
05641-0547
US

V. Phone/Fax

Practice location:
  • Phone: 802-371-5950
  • Fax: 802-371-5951
Mailing address:
  • Phone: 802-371-5950
  • Fax: 802-371-5951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0009585
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: