Provider Demographics
NPI:1417667817
Name:CUNLIFFE, SHAYLAN (MA)
Entity type:Individual
Prefix:
First Name:SHAYLAN
Middle Name:
Last Name:CUNLIFFE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MERCHANT ST
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-3871
Mailing Address - Country:US
Mailing Address - Phone:802-272-2545
Mailing Address - Fax:
Practice Address - Street 1:21 MERCHANT ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-3871
Practice Address - Country:US
Practice Address - Phone:802-272-2545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2025-12-04
Deactivation Date:2023-02-13
Deactivation Code:
Reactivation Date:2025-12-04
Provider Licenses
StateLicense IDTaxonomies
097.0134961390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT097.0134961OtherNON-LICENSED & NON-CERTIFIED PSYCHOTHERAPIST