Provider Demographics
NPI:1841417607
Name:WALSH, KEITH P (AUD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:P
Last Name:WALSH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARSETT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7150
Mailing Address - Country:US
Mailing Address - Phone:802-922-9545
Mailing Address - Fax:802-922-9546
Practice Address - Street 1:10 MARSETT RD STE 3
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482
Practice Address - Country:US
Practice Address - Phone:802-922-9545
Practice Address - Fax:802-922-9546
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT145.0117582231H00000X
NY14000079016237600000X
NY000685-01231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT001510201OtherMEDICARE PTAN
508120BMedicare ID - Type Unspecified