Individual provider · Type 1 NPI

Sophie Ann Shackley, PA-C

Medical Physician Assistant · Fitchburg, WI

NPI number 1376165548 Active

Practice location

5543 E Cheryl Pkwy
Fitchburg, WI 53711-5376

Mailing address

7588 E Technology Way Apt 203
Denver, CO 80237-3060

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X8537-23 (WI)

Medical Physician Assistant: Definition to come...

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About NPI 1376165548

Sophie Ann Shackley, PA-C's National Provider Identifier is 1376165548, issued on May 11, 2020. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Fitchburg, WI. The record was last updated on Sep 2, 2026.