Provider Demographics
NPI:1184376592
Name:MENARD, SHELBY ANNE
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ANNE
Last Name:MENARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WALNUT FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NH
Mailing Address - Zip Code:03858-4015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 CLARK WAY
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-4401
Practice Address - Country:US
Practice Address - Phone:603-692-2228
Practice Address - Fax:603-692-0418
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH077115-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner