Healthcare Provider Details

I. General information

NPI: 1689641086
Provider Name (Legal Business Name): JOHN W SHUCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S GOVERNORS AVE STE 201
DOVER DE
19904-3530
US

IV. Provider business mailing address

640 S STATE ST MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-4600
  • Fax: 302-672-4606
Mailing address:
  • Phone: 302-672-4600
  • Fax: 302-672-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC10006635
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: