Individual
SHELBY JOY SACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1698 E MCANDREWS RD STE 400, MEDFORD, OR 97504-5590
(541) 732-7874
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-7874
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA218037
OR
Other
Enumeration date
06/20/2022
Last updated
11/16/2023
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