Healthcare Provider Details

I. General information

NPI: 1083698112
Provider Name (Legal Business Name): JOHN V SHUFFLEBARGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 370N
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

123 SUMMER ST STE 370N
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-964-5580
  • Fax: 508-368-3957
Mailing address:
  • Phone: 508-964-5580
  • Fax: 508-368-3957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number79920
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number79920
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: