Provider Demographics
NPI:1376145003
Name:SHREWSBURY, ROY ELMO III
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:ELMO
Last Name:SHREWSBURY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DANIELS
Mailing Address - State:WV
Mailing Address - Zip Code:25832-9235
Mailing Address - Country:US
Mailing Address - Phone:304-894-4409
Mailing Address - Fax:
Practice Address - Street 1:1213 LAKE DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9235
Practice Address - Country:US
Practice Address - Phone:304-894-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator