Provider Demographics
NPI:1194343764
Name:SHAMBLIN, HERSCHEL GENE
Entity type:Individual
Prefix:
First Name:HERSCHEL
Middle Name:GENE
Last Name:SHAMBLIN
Suffix:
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 1:134 CONNER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1462
Mailing Address - Country:US
Mailing Address - Phone:304-205-5730
Mailing Address - Fax:
Practice Address - Street 1:134 CONNER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1462
Practice Address - Country:US
Practice Address - Phone:304-205-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator