Provider Demographics
NPI:1790226108
Name:SHELBURNE MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:SHELBURNE MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AYUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-277-3840
Mailing Address - Street 1:145 PINE HAVEN SHORES RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7703
Mailing Address - Country:US
Mailing Address - Phone:802-277-3840
Mailing Address - Fax:844-367-0017
Practice Address - Street 1:145 PINE HAVEN SHORES RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-277-3840
Practice Address - Fax:844-367-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies