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NPI Code Detail

MEDICARE: KATELYN SHEA MD

MEDICARE: KATELYN SHEA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician042-0014957VT
2207N00000XDermatology Physician308705-01NY
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1023470168
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN SHEA MD
Provider Business Mailing Address
First Line : 65 ETHAN ALLEN RD
Second Line :
City : JERICHO
State : VT
Zip : 05465-3120
Country : US
Telephone Number : 802-899-5133
Fax Number :
Provider Business Practice Location Address
First Line : 111 COLCHESTER AVE
Second Line :
City : BURLINGTON
State : VT
Zip : 05401-1473
Country : US
Telephone Number : 802-847-2700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2016
Last Update Date : 02/16/2026

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