Provider Demographics
NPI:1962638197
Name:WAITE, SHELLEY ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ROSE
Last Name:WAITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:57 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2141
Mailing Address - Country:US
Mailing Address - Phone:978-354-2795
Mailing Address - Fax:978-740-4748
Practice Address - Street 1:57 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2141
Practice Address - Country:US
Practice Address - Phone:978-354-2795
Practice Address - Fax:978-740-4748
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-56149208000000X
MA2473762084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics