Healthcare Provider Details

I. General information

NPI: 1629992300
Provider Name (Legal Business Name): BRENDA N SHATTUCK DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 STATE ST # 201
MONTPELIER VT
05602-3301
US

IV. Provider business mailing address

147 STATE ST
MONTPELIER VT
05602-3301
US

V. Phone/Fax

Practice location:
  • Phone: 802-793-1050
  • Fax:
Mailing address:
  • Phone: 802-793-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number026.0136926
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: