Healthcare Provider Details

I. General information

NPI: 1013831262
Provider Name (Legal Business Name): FULL CIRCLE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 IRELAND RD
BRISTOL VT
05443-5015
US

IV. Provider business mailing address

430 IRELAND RD
BRISTOL VT
05443-5015
US

V. Phone/Fax

Practice location:
  • Phone: 802-398-7040
  • Fax: 802-944-0120
Mailing address:
  • Phone: 802-398-7040
  • Fax: 802-944-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRENDAN C CONROY
Title or Position: NURSE PRACTITIONER - PRACTICE OWNER
Credential: APRN
Phone: 802-398-7040