Provider Demographics
NPI:1083681167
Name:DEMERS, SHAUN D (APRN)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:D
Last Name:DEMERS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATTN FINANCE DEPARTMENT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-225-1266
Mailing Address - Fax:802-479-3548
Practice Address - Street 1:82 E VIEW LN
Practice Address - Street 2:CVMC FAMILY PSYCHIATRY
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-5332
Practice Address - Country:US
Practice Address - Phone:802-225-1266
Practice Address - Fax:802-479-3548
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0123357163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT28387344002001OtherBCBS UT
UT000061568Medicare PIN