Individual
SHELLY A FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
38 MULBERRY ST STE 204, LEEDS, MA 01053-5339
(413) 727-3882
(413) 727-8691
Mailing address
PO BOX 313, LEEDS, MA 01053-0313
(413) 727-3882
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002021
CT
363A00000X
Physician Assistant
Primary
PA1051
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003020211
—
CT
Enumeration date
10/18/2007
Last updated
05/12/2021
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