Healthcare Provider Details

I. General information

NPI: 1194630376
Provider Name (Legal Business Name): SHELLEY MADELINE DAVIS MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2850
  • Fax: 802-847-5557
Mailing address:
  • Phone: 802-847-2850
  • Fax: 802-847-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number026.0112391
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: