Michael Wayne Shetley, ATC, CSCS
Individual provider Active NPI Athletic Trainer · Appomattox, VA
NPI 1346594264 · NPPES record last updated Oct 30, 2012
Key facts
- NPI
- 1346594264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- 0126000490 (VA)
- Practice address
- 198 Evergreen Ave
Appomattox, VA 24522 - Phone
- (804) 539-5080
- NPI assigned
- Oct 30, 2012
- Sex
- Male
- 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 |
|---|---|---|---|
| 0126000490 | VA | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 0126000490 | VA | Yes |
Addresses
Primary practice location
198 Evergreen Ave
Appomattox, VA 24522
Mailing address
179 Glenn Carson Rd
Prospect, VA 23960-2112
Phone (804) 539-5080
Other providers in Appomattox, VA
- Meredith Quarles
- Rector & Visitors of the University of Virginia
- Regal Medical Services, LTD.
- Tiffany Ross
- Victoria Ann Seal
- Katrina Archer Slagle
- Lisa W Smith
- Pamela Kaye Smith
- Jarred Alexander Sowards
- Kimberly Steger
All providers in Appomattox, VA · Athletic Trainer in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2012. 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.