Provider Demographics
NPI:1457546657
Name:PRENDEVILLE, M. SHEILA (NP)
Entity type:Individual
Prefix:MS
First Name:M.
Middle Name:SHEILA
Last Name:PRENDEVILLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 COURT ST
Mailing Address - Street 2:STE 1
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-8710
Mailing Address - Country:US
Mailing Address - Phone:508-477-1318
Mailing Address - Fax:508-747-1410
Practice Address - Street 1:116 COURT ST STE 1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-8710
Practice Address - Country:US
Practice Address - Phone:087-471-3185
Practice Address - Fax:508-747-1410
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA260795364SF0001X
MAMP06906831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA260795OtherLICENSE