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General NPI Number Information
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NPI Number | 1861479784
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Entity Type | Individual
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Provider Name | SHELLY P KAFKA M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 399 EMILY DR
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City | CLARKSBURG
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State | WV
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Zip | 26301-5505
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Country | US
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Telephone | 304-624-4315
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Fax | 304-624-4319
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Provider Business Mailing Address
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Address Line | 125 N 6TH ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2665
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Country | US
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Telephone | 304-624-7200
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Fax | 304-624-4319
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 21978
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License Number State | WV
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