Provider Demographics
NPI:1699902726
Name:SHACKELTON, JEFFREY B (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:SHACKELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 G S RICHARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703
Mailing Address - Country:US
Mailing Address - Phone:775-882-8777
Mailing Address - Fax:775-283-4081
Practice Address - Street 1:640 W. MOANA LANE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-324-0699
Practice Address - Fax:775-323-6814
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD185082207ND0900X
NV14618207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology