Provider Demographics
NPI:1275153942
Name:SHOFF, KELSEY BROOKE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:BROOKE
Last Name:SHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 WATER ST UNIT 32
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-9810
Mailing Address - Country:US
Mailing Address - Phone:802-688-9750
Mailing Address - Fax:
Practice Address - Street 1:314 EXETER RD
Practice Address - Street 2:
Practice Address - City:HAMPTON FALLS
Practice Address - State:NH
Practice Address - Zip Code:03844-2000
Practice Address - Country:US
Practice Address - Phone:802-688-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055.0031502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant