Provider Demographics
NPI:1144309303
Name:SHEDD, WENDY APRIL (PAC)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:APRIL
Last Name:SHEDD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6212
Mailing Address - Country:US
Mailing Address - Phone:802-660-8808
Mailing Address - Fax:802-660-4310
Practice Address - Street 1:372 DORSET ST
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-660-8808
Practice Address - Fax:802-660-4310
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102912363A00000X
VT0550031408363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
63440Medicare ID - Type Unspecified
Q25716Medicare UPIN