Provider Demographics
NPI:1376839332
Name:BURDICK, SHELLIE (DO)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:
Last Name:BURDICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7237 ROUTE 7
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261-9494
Mailing Address - Country:US
Mailing Address - Phone:802-681-2780
Mailing Address - Fax:833-344-1372
Practice Address - Street 1:7237 ROUTE 7
Practice Address - Street 2:
Practice Address - City:POWNAL
Practice Address - State:VT
Practice Address - Zip Code:05261-9494
Practice Address - Country:US
Practice Address - Phone:802-681-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014123207Q00000X
CA20A13173207Q00000X
MA293296207Q00000X
VT032.0133921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine