Provider Demographics
NPI:1942755921
Name:SHEDD, SUSAN (MA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHEDD
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 1:943 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST CALAIS
Mailing Address - State:VT
Mailing Address - Zip Code:05650-8257
Mailing Address - Country:US
Mailing Address - Phone:802-456-7088
Mailing Address - Fax:
Practice Address - Street 1:943 SAND HILL RD
Practice Address - Street 2:
Practice Address - City:EAST CALAIS
Practice Address - State:VT
Practice Address - Zip Code:05650-8257
Practice Address - Country:US
Practice Address - Phone:802-456-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT47-0000540103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist