Provider Demographics
NPI:1508192584
Name:DR. SHIRLEY OXIDINE, PLLC
Entity Type:Organization
Organization Name:DR. SHIRLEY OXIDINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OXIDINE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:802-388-3202
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-0051
Mailing Address - Country:US
Mailing Address - Phone:802-388-3202
Mailing Address - Fax:802-654-7601
Practice Address - Street 1:10 MERCHANTS ROW
Practice Address - Street 2:SUITE 215
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1421
Practice Address - Country:US
Practice Address - Phone:802-388-3202
Practice Address - Fax:802-654-7601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT048-000838OtherPSYCHOLOGIST
VT1010656Medicaid
VT048-000838OtherPSYCHOLOGIST