Provider Demographics
NPI:1679587539
Name:MEHAFFEY, WENDY (DC)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:MEHAFFEY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 KIMBALL AVE
Mailing Address - Street 2:STE 201 A
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6805
Mailing Address - Country:UM
Mailing Address - Phone:802-343-3900
Mailing Address - Fax:
Practice Address - Street 1:4357 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7101
Practice Address - Country:US
Practice Address - Phone:802-343-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0071807111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC550598Medicare ID - Type Unspecified