Provider Demographics
NPI:1932317070
Name:CARDAMONE, SHELIA KATHLEEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:KATHLEEN
Last Name:CARDAMONE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WINTERCROFT CIRCLE
Mailing Address - Street 2:P.O.BOX 24
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753
Mailing Address - Country:US
Mailing Address - Phone:603-863-1908
Mailing Address - Fax:
Practice Address - Street 1:33 WINTERCROFT CIRCLE
Practice Address - Street 2:
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753
Practice Address - Country:US
Practice Address - Phone:603-863-1908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0396225100000X
VT0400002637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0396OtherPT LICENSE #
VT0400002637OtherPT LICENSE #
NH30392912Medicaid
VT68028OtherVT. BLUE CROSS #
08Y007129NH01OtherANTHEM BILLING #
NH30392912Medicaid