Healthcare Provider Details

I. General information

NPI: 1134259278
Provider Name (Legal Business Name): SHAWN EDWARD STRICKLAND DMSC, MPAS, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 FLORENCE STREET
ANSTED WV
25812
US

IV. Provider business mailing address

101 FLORENCE ST
ANSTED WV
25812
US

V. Phone/Fax

Practice location:
  • Phone: 304-658-5100
  • Fax: 304-658-3375
Mailing address:
  • Phone: 304-658-6007
  • Fax: 304-658-6017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1233
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: