Provider Demographics
NPI:1437445038
Name:BRANCIERI, SHANNON MELISSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MELISSA
Last Name:BRANCIERI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:784 HERCULES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8049
Mailing Address - Country:US
Mailing Address - Phone:802-448-9787
Mailing Address - Fax:802-448-9787
Practice Address - Street 1:4 BIRCH ST
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2136
Practice Address - Country:US
Practice Address - Phone:603-635-2802
Practice Address - Fax:603-635-3070
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARM2304686363LF0000X
NY336834363LX0001X
NH072588-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3120836Medicaid