Healthcare Provider Details

I. General information

NPI: 1891955506
Provider Name (Legal Business Name): SHANNON H PHIBBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHARLESTOWN RD
SPRINGFIELD VT
05156-4400
US

IV. Provider business mailing address

20 ANNA MARIA DR
LACONIA NH
03246-3286
US

V. Phone/Fax

Practice location:
  • Phone: 802-909-2012
  • Fax:
Mailing address:
  • Phone: 802-909-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60685173
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: