Individual
STACEY L SHADIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2865 CHANCELLOR DR, SUITE 225, CRESTVIEW HILLS, KY 41017-3912
(859) 341-5400
(859) 578-3172
Mailing address
2865 CHANCELLOR DR, SUITE 225, CRESTVIEW HILLS, KY 41017-3912
(859) 341-5400
(859) 578-3172
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50-00-2367
OH
363A00000X
Physician Assistant
Primary
PA1136
KY
Other
Enumeration date
12/01/2006
Last updated
10/16/2008
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