Provider Demographics
NPI:1740625565
Name:KEALY, SHEVAUGHN M (MD)
Entity type:Individual
Prefix:
First Name:SHEVAUGHN
Middle Name:M
Last Name:KEALY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:VETERANS AFFAIRS MEDICAL CENTER
Mailing Address - Street 2:421 NORTH MAIN STREET
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-9764
Mailing Address - Country:US
Mailing Address - Phone:413-584-4040
Mailing Address - Fax:413-582-3107
Practice Address - Street 1:143 MUNSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9694
Practice Address - Country:US
Practice Address - Phone:413-773-8428
Practice Address - Fax:413-582-3164
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2024-06-10
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Provider Licenses
StateLicense IDTaxonomies
MA261914207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400255613Medicare PIN