Provider Demographics
NPI:1447436407
Name:ALASKY, DESIRAE SHAVON (DO)
Entity type:Individual
Prefix:DR
First Name:DESIRAE
Middle Name:SHAVON
Last Name:ALASKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DESIRAE
Other - Middle Name:SHAVON
Other - Last Name:FRAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1912 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1239
Mailing Address - Country:US
Mailing Address - Phone:304-363-3500
Mailing Address - Fax:
Practice Address - Street 1:1664 E PIKE ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-6011
Practice Address - Country:US
Practice Address - Phone:304-709-7000
Practice Address - Fax:304-624-1780
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810018572Medicaid
WV3810018572Medicaid