Provider Demographics
NPI:1346919222
Name:SHUCK, TERRI
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:SHUCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BOEING ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-9206
Mailing Address - Country:US
Mailing Address - Phone:304-890-7479
Mailing Address - Fax:
Practice Address - Street 1:122 BOEING ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-9206
Practice Address - Country:US
Practice Address - Phone:304-890-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker