Provider Demographics
NPI:1780337410
Name:DAGGETT, SHELLEY LYNN
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:LYNN
Last Name:DAGGETT
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 1:50 HORNBEAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1346
Mailing Address - Country:US
Mailing Address - Phone:978-479-5124
Mailing Address - Fax:
Practice Address - Street 1:50 HORNBEAM HILL RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1346
Practice Address - Country:US
Practice Address - Phone:978-479-5124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker