Individual
DR. STACY ANN SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4102 PINION DR, USAF ACADEMY, CO 80840-2502
(719) 333-5140
Mailing address
4102 PINION DR, USAF ACADEMY, CO 80840-2502
(719) 333-5140
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
280123-1205
UT
2086S0127X
Trauma Surgery Physician
Primary
DR.0068946
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
441150100
—
MD
Enumeration date
10/11/2005
Last updated
10/13/2025
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