Shelby Nicole Burruss
Individual provider Active NPI Surgical Assistant · Mount Nebo, WV
NPI 1124860184 · NPPES record last updated Jun 11, 2024
Key facts
- NPI
- 1124860184
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Assistant 246ZC0007X
- License
- 100272622 (WV)
- Practice address
- 759 Summersville Lake Rd
Mount Nebo, WV 26679-9203 - Phone
- (304) 640-6417
- NPI assigned
- Jun 11, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100272622 | WV | MD | Surgical Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 100272622 | WV | Yes |
Addresses
Primary practice location
759 Summersville Lake Rd
Mount Nebo, WV 26679-9203
Mailing address
759 Summersville Lake Rd
Mount Nebo, WV 26679-9203
Phone (304) 640-6417
Other providers in Mount Nebo, WV
- Sapphire Brown
- Suzette M Bruce
- Michelle Bryant
- Loretta Ann Buck
- Kala M Bunch
- Rita Byrd
- Brianne D Cable
- Camden on Gauley Medical Center Inc
- Faith Canter
- David Paul Carpenter
All providers in Mount Nebo, WV · Surgical Assistant in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.