Provider Demographics
NPI:1851402663
Name:NETT, SHOLEEN T (MD/PHD)
Entity type:Individual
Prefix:
First Name:SHOLEEN
Middle Name:T
Last Name:NETT
Suffix:
Gender:F
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOLLENBECK LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-3112
Mailing Address - Country:US
Mailing Address - Phone:603-277-9380
Mailing Address - Fax:
Practice Address - Street 1:BAYSTATE CHILDREN'S HOSPITAL 759 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1000
Practice Address - Country:US
Practice Address - Phone:413-794-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12313208000000X, 2080P0203X
MA2314032080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072579Medicaid
VT1010843Medicaid
MA110075815AMedicaid