Individual
VIOLET PATTY SHACKLEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 MEDICAL CENTER DRIVE, ROOM 4601, MORGANTOWN, WV 26506
(304) 598-0430
Mailing address
1 MEDICAL CENTER DRIVE, ROOM 4601, PO BOX 9238, MORGANTOWN, WV 26506
(304) 598-0430
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
29882
WV
207L00000X
Anesthesiology Physician
35.150401
OH
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
59016
KY
Other
Enumeration date
03/24/2018
Last updated
09/25/2024
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