Provider Demographics
NPI:1215100664
Name:SHATTUCK, TRISHA MILLER (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:MILLER
Last Name:SHATTUCK
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:ELLEN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 96782
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28296-6782
Mailing Address - Country:US
Mailing Address - Phone:704-973-5500
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD FL 4
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-973-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-01575207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology