MEDICARE: SHELBURNE PEDIATRICS

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
1	208000000X	Pediatrics Physician		VT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164624300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBURNE PEDIATRICS

Provider Business Mailing Address
First Line	:	10 MARSETT RD
Second Line	:	SUITE 2
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6640
Country	:	US
Telephone Number	:	802-985-5099
Fax Number	:	802-985-2336

Provider Business Practice Location Address
First Line	:	10 MARSETT RD
Second Line	:	SUITE 2
City	:	SHELBURNE
State	:	VT
Zip	:	05482-6640
Country	:	US
Telephone Number	:	802-985-5099
Fax Number	:	802-985-2336

Authorized Official
Title or Position	:	OWNER
Name	:	JEANNE KELLNER
Credential	:	MD
Telephone Number	:	802-985-5099

Provider Enumeration Date	:	06/01/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1063400190 — KAREN CLEARY M.D.
Practice Location Address:

10 MARSETT RD , STE 1
SHELBURNE, VT
05482-6640

Practice Phone: 802-985-8055
Practice Fax:

1760559108 — DR. JEANNE RODSETH KELLNER MD
Practice Location Address:

10 MARSETT ROAD , SUITE 2
SHELBURNE, VT
05482-6640

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Practice Fax: 802-985-2336

1134268550 — ELIZABETH ANNE SCHEUERMAN L.AC.,L.H.,DIPL.OM
Practice Location Address:

10 MARSETT RD , SUITE 4
SHELBURNE, VT
05482-6640

Practice Phone: 802-985-0718
Practice Fax:

1912117847 — MS. KATHLEEN REO FNP
Practice Location Address:

10 MARSETT RD STE 2
SHELBURNE, VT
05482-6640

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Practice Fax:

1437154986 — DR. DAVID H PIERSON D.C.
Practice Location Address:

4066 SHELBURNE RD , #8
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1477535219 — DR. LINDA VIETH ROSENBLAD PH.D.
Practice Location Address:

5224 SHELBURNE RD
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Practice Phone: 802-598-9265
Practice Fax:

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