Provider Demographics
NPI:1447032115
Name:SHELBURNE MIND BODY MEDICINE LLC
Entity type:Organization
Organization Name:SHELBURNE MIND BODY MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:NORA
Authorized Official - Last Name:FAIBISH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:802-448-4408
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-0042
Mailing Address - Country:US
Mailing Address - Phone:802-448-4408
Mailing Address - Fax:802-341-6595
Practice Address - Street 1:161 FERRY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:VT
Practice Address - Zip Code:05445-9901
Practice Address - Country:US
Practice Address - Phone:802-448-4408
Practice Address - Fax:802-341-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty