Provider Demographics
NPI:1598053621
Name:SHACKELFORD, MEGHAN J (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:J
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 GLEN ARBOR CT
Mailing Address - Street 2:
Mailing Address - City:SEVEN VALLEYS
Mailing Address - State:PA
Mailing Address - Zip Code:17360
Mailing Address - Country:US
Mailing Address - Phone:443-415-2903
Mailing Address - Fax:
Practice Address - Street 1:600 N. WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21284
Practice Address - Country:US
Practice Address - Phone:410-955-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-11
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR170221363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care