Healthcare Provider Details

I. General information

NPI: 1841417607
Provider Name (Legal Business Name): KEITH P WALSH AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MARSETT RD STE 3
SHELBURNE VT
05482
US

IV. Provider business mailing address

10 MARSETT RD STE 3
SHELBURNE VT
05482-7150
US

V. Phone/Fax

Practice location:
  • Phone: 802-922-9545
  • Fax: 802-922-9546
Mailing address:
  • Phone: 802-922-9545
  • Fax: 802-922-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number145.0117582
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number14000079016
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number000685-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: