Shady Grove Farm and Wellness Center

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

011853-1 Issued in NY

Legal business name

SHADY GROVE FARM AND WELLNESS CENTER

Practice address

844 State Route 22B
Peru, NY 12972-5421

Phone

(518) 569-3440

NPI assigned

Feb 28, 2013

Organization subpart

No

Name

Karen M Bouchard-Braun, PT

Title

President

Phone

(518) 569-3440

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karen M Bouchard, PT, NCS

  • Specialist
  • Plattsburgh, NY
  • NPI 1437370327
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 28, 2013.

{
    "created_epoch": "1362009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362009600000",
    "number": "1326388331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "844 STATE ROUTE 22B",
            "city": "PERU",
            "state": "NY",
            "postal_code": "129725421",
            "telephone_number": "518-569-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "844 STATE ROUTE 22B",
            "city": "PERU",
            "state": "NY",
            "postal_code": "129725421",
            "telephone_number": "518-569-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADY GROVE FARM AND WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-28",
        "last_updated": "2013-02-28",
        "status": "A",
        "authorized_official_last_name": "BOUCHARD-BRAUN",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-569-3440",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NY",
            "license": "011853-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peru Family Medicine, PLLC
• Peru Pharmacy Inc.
• Alison Rosenbaum, LMHC
• Michelle Marie Rushby, NURSE PRACTITIONER
• Brittany Patinka Saunders, RN
• Lawrence Kenneth Shanley, PHARM. D
• Lawrence Ketrick Shanley, RPH
• David W Smith, M.D.
• Sara Spear, LMHC
• Vicki Sue Tedford, SNT

• All providers in Peru, NY
• Early Intervention Provider Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.