Provider Demographics
NPI:1942595228
Name:RIVARD, SHAYNA COLLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:COLLEEN
Last Name:RIVARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ADULT & PEDIATRIC DERMATOLOGY, PC
Mailing Address - Street 2:55 MILL STREET
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894
Mailing Address - Country:US
Mailing Address - Phone:603-626-7546
Mailing Address - Fax:603-569-5046
Practice Address - Street 1:55 MILL ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4328
Practice Address - Country:US
Practice Address - Phone:603-569-3376
Practice Address - Fax:603-569-5046
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2025-07-17
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-20
Provider Licenses
StateLicense IDTaxonomies
NH22256207N00000X, 207ND0101X
VA0101252746207N00000X
TXT6024207N00000X
TNMD0000064760207N00000X
FLME144349207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101252746OtherVIRGINIA BOARD OF MEDICINE
FLME144349OtherFLORIDA DEPARTMENT OF HEALTH
TXT6024OtherTEXAS MEDICAL BOARD
TN0000064760OtherTENNESSEE DEPARTMENT OF HEALTH
NH22256OtherNEW HAMPSHIRE BOARD OF MEDICINE