Individual
CHRISTOPHER SHACKLEFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3509 N BROAD ST STE 226, PHILADELPHIA, PA 19140-4105
(215) 707-9837
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5151015252
MI
207RN0300X
Nephrology Physician
Primary
OT023189
PA
Other
Enumeration date
06/02/2021
Last updated
06/24/2024
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