Healthcare Provider Details

I. General information

NPI: 1265018196
Provider Name (Legal Business Name): KASEY SHALLENBURG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 S STERLING ST
MORGANTON NC
28655-4044
US

IV. Provider business mailing address

117 FOOTHILLS DR
MORGANTON NC
28655-5152
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024-02723
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: