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General NPI Number Information
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NPI Number | 1972732857
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Entity Type | Organization
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Legal Business Name | DR PAMELA SHACKLEY DC PA
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Dates
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Enumeration Date | 07/13/2009
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 1217 S EAST AVE SUITE 207
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City | SARASOTA
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State | FL
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Zip | 34239-2344
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Country | US
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Telephone | 941-955-6080
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Fax | 941-957-1142
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Provider Business Mailing Address
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Address Line | 1217 S EAST AVE SUITE 207
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City | SARASOTA
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State | FL
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Zip | 34239-2344
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Country | US
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Telephone | 941-955-6080
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Fax | 941-957-1142
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. PAMELA D SHACKLEY
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Credential | DC
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Telephone | 941-955-6080
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH3827
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License Number State | FL
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