Individual
THOMAS JOSEPH SHADDIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1354 BULL LEA RD, LEXINGTON, KY 40511-1247
(859) 562-3899
(859) 257-6200
Mailing address
101 MARJORIE PL, GEORGETOWN, KY 40324-8048
(859) 979-5482
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2304
KY
363AM0700X
Medical Physician Assistant
PA2304
KY
363AS0400X
Surgical Physician Assistant
PA2304
KY
Other
Enumeration date
08/30/2017
Last updated
02/19/2025
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