Provider Demographics
NPI:1417999434
Name:SHEDLACK, KAREN J (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:SHEDLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220R FORBES ROAD
Mailing Address - Street 2:DEPARTMENT OF DEVELOPMENTAL DISABILITIES
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184
Mailing Address - Country:US
Mailing Address - Phone:617-855-2577
Mailing Address - Fax:781-356-8858
Practice Address - Street 1:220R FORBES ROAD
Practice Address - Street 2:DEPARTMENT OF DEVELOPMENTAL DISABILITIES
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:617-855-2577
Practice Address - Fax:781-356-8858
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA566452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08696OtherBCBS
MA3162869Medicaid
MA3162869Medicaid