Provider Demographics
NPI:1346277167
Name:SHELBURNE, LINDA L (NP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:L
Last Name:SHELBURNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:GRANTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-0160
Mailing Address - Country:US
Mailing Address - Phone:508-888-5817
Mailing Address - Fax:
Practice Address - Street 1:35 CEDAR ST
Practice Address - Street 2:CAPE COD INTERNAL MEDICINE WM N FENNEY MD
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-778-6363
Practice Address - Fax:508-778-6674
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173418363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6169295Medicaid
NP3169OtherBC
NP3169Medicare ID - Type Unspecified
MA6169295Medicaid