Provider Demographics
NPI:1629817812
Name:FLANAGAN, TIM SHAUN
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:SHAUN
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 LAMPLITE LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7709
Mailing Address - Country:US
Mailing Address - Phone:802-272-7391
Mailing Address - Fax:
Practice Address - Street 1:513 LAMPLITE LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7709
Practice Address - Country:US
Practice Address - Phone:802-272-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach