Provider Demographics
NPI:1407741085
Name:BRAZZ, SHEYLAH JANE
Entity type:Individual
Prefix:
First Name:SHEYLAH
Middle Name:JANE
Last Name:BRAZZ
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 1:80 VARNUM POND RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:ME
Mailing Address - Zip Code:04984-3006
Mailing Address - Country:US
Mailing Address - Phone:207-491-1278
Mailing Address - Fax:
Practice Address - Street 1:411 US-2
Practice Address - Street 2:SUITE C
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294
Practice Address - Country:US
Practice Address - Phone:207-645-1668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
META4829224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant