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General NPI Number Information
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NPI Number | 1215925672
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Entity Type | Individual
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Provider Name | STACY ANN SHACKELFORD M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 4102 PINION DR
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City | USAF ACADEMY
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State | CO
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Zip | 80840-2502
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Country | US
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Telephone | 719-333-5140
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Fax |
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Provider Business Mailing Address
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Address Line | 4102 PINION DR
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City | USAF ACADEMY
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State | CO
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Zip | 80840-2502
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Country | US
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Telephone | 719-333-5140
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 280123-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | DR.0068946
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License Number State | CO
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