MEDICARE: TAYLOR L SHACKLEFORD

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	207X00000X	Orthopaedic Surgery Physician	TP839	KY
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207XS0106X	Orthopaedic Hand Surgery Physician	TP839	KY

General Provider Information

NPI Number	:	1740784768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR L SHACKLEFORD

Provider Business Mailing Address
First Line	:	1 MEDICAL CENTER DR
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26506-1200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 HARRODSBURG RD 2ND FL
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-7306
Country	:	US
Telephone Number	:	859-323-4263
Fax Number	:

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

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	02/04/2026

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