Provider Demographics
NPI:1548528870
Name:MAY, SHAWN R (PA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:R
Last Name:MAY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:74 MUNSILL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRISTOL
Mailing Address - State:VT
Mailing Address - Zip Code:05443-1032
Mailing Address - Country:US
Mailing Address - Phone:802-453-5028
Mailing Address - Fax:802-453-6105
Practice Address - Street 1:74 MUNSILL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRISTOL
Practice Address - State:VT
Practice Address - Zip Code:05443-1032
Practice Address - Country:US
Practice Address - Phone:802-453-5028
Practice Address - Fax:802-453-6105
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT089.00010821041C0700X
VT055.0031128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000563Medicaid
2656302Medicare PIN