Provider Demographics
NPI:1376226175
Name:DR. SHELLIE BURDICK LLC
Entity Type:Organization
Organization Name:DR. SHELLIE BURDICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:802-732-3010
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:NORTH BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05257-0011
Mailing Address - Country:US
Mailing Address - Phone:802-732-3010
Mailing Address - Fax:802-732-3012
Practice Address - Street 1:10 BANK ST
Practice Address - Street 2:
Practice Address - City:NORTH BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05257-9101
Practice Address - Country:US
Practice Address - Phone:802-732-3010
Practice Address - Fax:802-732-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care