Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 042-0014957 | VT |
NPI | 1023470168 |
---|---|
Provider Name | Katelyn Shea |
First Address | Jericho, VT 05465-3120 |
Second Address | Burlington, VT 05401-1473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 23/11/2020 |