Healthcare Provider Details

I. General information

NPI: 1982908224
Provider Name (Legal Business Name): MATTHEW ANTHONY SBARDELLA F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ANNA MARSH LANE
BRATTLEBORO VT
05302
US

IV. Provider business mailing address

P.O. BOX 803
BRATTLEBORO VT
05301
US

V. Phone/Fax

Practice location:
  • Phone: 180-073-8732
  • Fax:
Mailing address:
  • Phone: 180-073-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0073157
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: