1942595228 NPI number — DR. SHAYNA COLLEEN RIVARD MD

Table of content: DR. SHAYNA COLLEEN RIVARD MD (NPI 1942595228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942595228 NPI number — DR. SHAYNA COLLEEN RIVARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVARD
Provider First Name:
SHAYNA
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942595228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/25/2020
NPI Reactivation Date:
03/20/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ADULT & PEDIATRIC DERMATOLOGY, PC
Provider Second Line Business Mailing Address:
55 MILL STREET
Provider Business Mailing Address City Name:
WOLFEBORO
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-626-7546
Provider Business Mailing Address Fax Number:
603-569-5046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 MILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOLFEBORO
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03894-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-569-3376
Provider Business Practice Location Address Fax Number:
603-569-5046
Provider Enumeration Date:
06/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  22256 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: 0101252746 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: T6024 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: MD0000064760 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207N00000X , with the licence number: ME144349 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X , with the licence number: 22256 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0101252746 . This is a "VIRGINIA BOARD OF MEDICINE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: ME144349 . This is a "FLORIDA DEPARTMENT OF HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: T6024 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0000064760 . This is a "TENNESSEE DEPARTMENT OF HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 22256 . This is a "NEW HAMPSHIRE BOARD OF MEDICINE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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