=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417999434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN J SHEDLACK M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2006
-----------------------------------------------------
Last Update Date | 03/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220R FORBES ROAD DEPARTMENT OF DEVELOPMENTAL DISABILITIES
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-855-2577
-----------------------------------------------------
Fax | 781-356-8858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220R FORBES ROAD DEPARTMENT OF DEVELOPMENTAL DISABILITIES
-----------------------------------------------------
City | BRAINTREE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-855-2577
-----------------------------------------------------
Fax | 781-356-8858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 56645
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------