Provider Demographics
NPI:1578380192
Name:SCALF, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SCALF
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 MAYOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:CLOTHIER
Mailing Address - State:WV
Mailing Address - Zip Code:25047
Mailing Address - Country:US
Mailing Address - Phone:304-784-8905
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 62
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-0062
Practice Address - Country:US
Practice Address - Phone:681-422-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide