Healthcare Provider Details

I. General information

NPI: 1942736517
Provider Name (Legal Business Name): AMBER SHADOAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 ROLLING HILLS BLVD
MONTICELLO KY
42633-9004
US

IV. Provider business mailing address

PO BOX 1737
MONTICELLO KY
42633-4737
US

V. Phone/Fax

Practice location:
  • Phone: 606-753-0293
  • Fax: 606-753-0291
Mailing address:
  • Phone: 606-753-0293
  • Fax: 606-753-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55801
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: