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NPI Code Detail

MEDICARE: DR. STACY ANN SHACKELFORD M.D.

MEDICARE: DR. STACY ANN SHACKELFORD M.D.
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
1208600000XSurgery Physician280123-1205UT
22086S0127XTrauma Surgery PhysicianDR.0068946CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215925672
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACY ANN SHACKELFORD M.D.
Provider Business Mailing Address
First Line : 4102 PINION DR
Second Line :
City : USAF ACADEMY
State : CO
Zip : 80840-2502
Country : US
Telephone Number : 719-333-5140
Fax Number :
Provider Business Practice Location Address
First Line : 4102 PINION DR
Second Line :
City : USAF ACADEMY
State : CO
Zip : 80840-2502
Country : US
Telephone Number : 719-333-5140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 10/13/2025

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