Provider Demographics
NPI:1770210841
Name:BELLIVEAU, SHAMMI L (LPN)
Entity type:Individual
Prefix:
First Name:SHAMMI
Middle Name:L
Last Name:BELLIVEAU
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SHAMMI
Other - Middle Name:L
Other - Last Name:SHOEMAKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:10 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2226
Practice Address - Country:US
Practice Address - Phone:802-885-7280
Practice Address - Fax:802-885-2683
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0134737164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse