Provider Demographics
NPI:1861479784
Name:KAFKA, SHELLY P (MD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:P
Last Name:KAFKA
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 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-624-4319
Practice Address - Street 1:399 EMILY DR
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-5505
Practice Address - Country:US
Practice Address - Phone:304-624-4315
Practice Address - Fax:304-624-4319
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21978207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003522Medicaid
WVF56751Medicare UPIN
WV3810003522Medicaid