Alex H. Shacklette, MD

Primary specialty

Molecular Genetic Pathology (Pathology) PhysicianTaxonomy code 207ZP0007X

License

14188290-1205 Issued in UT

Practice address

Eccles Institute of Human Genetics: 15 N Medical Dr RM
Salt Lake City, UT 84112-4108

Phone

(801) 581-2121

NPI assigned

Apr 30, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1700440252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ECCLES INSTITUTE OF HUMAN GENETICS: 15 N MEDICAL DR RM",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841124108",
            "telephone_number": "801-581-2121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ECCLES INSTITUTE OF HUMAN GENETICS: 15 N MEDICAL DR RM",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841124108",
            "telephone_number": "801-581-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 W 11th St Rm 4083",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462024108",
            "country_code": "US",
            "telephone_number": "317-491-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHACKLETTE",
        "first_name": "ALEX",
        "middle_name": "H.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-30",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": "UT",
            "license": "14188290-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracie A Sexton, MS-CCC-SLP
• Alan Seyboldt, OPTICIAN
• Sfaba Ut LLC
• Akram M. Shaaban, MBBCH
• Rachel Marie Shackelford, MOTR/L
• Jessica Shade
• L Kristin Shadow, MD
• Hallie Kendall Shafer
• Andrea Dawn Shaffer
• Robert Matthew Shaffer

• Molecular Genetic Pathology (Pathology) Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Molecular Genetic Pathology (Pathology) Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.