Provider Demographics
NPI:1902004690
Name:MATHEW, SHEMILY ABY
Entity Type:Individual
Prefix:MRS
First Name:SHEMILY
Middle Name:ABY
Last Name:MATHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SHEMILY
Other - Middle Name:BABY
Other - Last Name:KUNNATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 FORT ST
Mailing Address - Street 2:APT# 12
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1619
Mailing Address - Country:US
Mailing Address - Phone:207-498-3229
Mailing Address - Fax:
Practice Address - Street 1:163 VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3567
Practice Address - Country:US
Practice Address - Phone:207-498-1618
Practice Address - Fax:207-498-1653
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2997225100000X
NY029213-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist