Individual
SHELLEY AMBER GAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
401 DIVISION ST STE 306, SOUTH CHARLESTON, WV 25309-1455
(304) 766-4300
(304) 766-5474
Mailing address
PO BOX 3466, CHARLESTON, WV 25334-3466
(888) 239-8370
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01513
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720396872
—
WV
Enumeration date
09/22/2010
Last updated
10/05/2023
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