Healthcare Provider Details

I. General information

NPI: 1093507170
Provider Name (Legal Business Name): STEPHEN PAULUS DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 PINE HAVEN SHORES RD STE 2061
SHELBURNE VT
05482-7815
US

IV. Provider business mailing address

145 PINE HAVEN SHORES RD STE 2061
SHELBURNE VT
05482-7815
US

V. Phone/Fax

Practice location:
  • Phone: 802-489-5470
  • Fax: 802-497-0867
Mailing address:
  • Phone: 802-489-5470
  • Fax: 802-497-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN PAULUS
Title or Position: PHYSICIAN
Credential: DO
Phone: 802-489-5470