Healthcare Provider Details

I. General information

NPI: 1780661223
Provider Name (Legal Business Name): SCOTT F SHOMO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S CRIM AVE
BELINGTON WV
26250-8416
US

IV. Provider business mailing address

70 N STURMER ST
BELINGTON WV
26250-7403
US

V. Phone/Fax

Practice location:
  • Phone: 304-823-3080
  • Fax: 304-823-1981
Mailing address:
  • Phone: 304-823-2800
  • Fax: 304-823-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number653
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: