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General NPI Number Information
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NPI Number | 1447032115
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Entity Type | Organization
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Legal Business Name | SHELBURNE MIND BODY MEDICINE LLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 161 FERRY RD
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City | CHARLOTTE
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State | VT
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Zip | 05445-9901
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Country | US
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Telephone | 802-448-4408
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Fax | 802-341-6595
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Provider Business Mailing Address
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Address Line | PO BOX 42
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City | CHARLOTTE
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State | VT
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Zip | 05445-0042
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Country | US
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Telephone | 802-448-4408
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Fax | 802-341-6595
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DARCY NORA FAIBISH
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Credential | NP
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Telephone | 802-448-4408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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