Provider Demographics
NPI:1114083557
Name:SHANK, CRISCHELLE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISCHELLE
Middle Name:L
Last Name:SHANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FAIRVIEW HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9301
Mailing Address - Country:US
Mailing Address - Phone:304-872-5090
Mailing Address - Fax:717-544-4149
Practice Address - Street 1:350 FAIRVIEW HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9301
Practice Address - Country:US
Practice Address - Phone:304-842-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22967207Q00000X
PAMD431895207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine