MEDICARE: MARISSA M SHUFFIELD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA06234	TX

General Provider Information

NPI Number	:	1013146257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA M SHUFFIELD PA

Provider Business Mailing Address
First Line	:	2005 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4779
Country	:	US
Telephone Number	:	817-598-5620
Fax Number	:	817-598-5621

Provider Business Practice Location Address
First Line	:	2005 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4779
Country	:	US
Telephone Number	:	817-598-5620
Fax Number	:	817-598-5621

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	01/09/2020

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