SOPHIE ANN SHACKLEY PA-C
NPI 1376165548
Physician Assistant - Medical in Fitchburg, WI

Q: What is Sophie Shackley's NPI number?

The NPI number for Sophie Shackley is 1376165548. It was assigned to this individual provider in the NPPES registry on May 11, 2020.

Q: What is Sophie Shackley's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Sophie Shackley was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 11, 2020PECOS Enrolled

5543 E CHERYL PKWY, FITCHBURG, WI 53711(608) 274-5300 Get Directions Write a Review

NPPES record last updated: September 2, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Sep 2, 2026, Mar 13, 2026, Oct 11, 2021 and 4 more (7 updates tracked since 2020).

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About Sophie Ann Shackley Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOPHIE ANN SHACKLEY PA-C (NPI 1376165548) is an individual medical provider in Fitchburg, Wisconsin, licensed in Wisconsin (8537-23) and active in the NPI registry since May 2020. She is enrolled in Medicare PECOS, is affiliated with University Of Wi Hospitals & Clinics Authority, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1376165548

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameSOPHIE ANN SHACKLEYCredential: PA-C

Location Address5543 E CHERYL PKWYFitchburg, WI 53711-5376

Mailing Address7588 E Technology Way Apt 203Denver, CO 80237-3060

Phone(608) 274-5300

Sole ProprietorYes

Medical School CMSOtherGraduated 2021

Enumeration DateMay 11, 2020

Last NPPES UpdateSeptember 2, 20267 updates tracked since enumeration

NPPES CertifiedSeptember 2, 2026

✔ NPI 1376165548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in WI · 8537-23

5543 E CHERYL PKWY, Fitchburg, WI 53711

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Security Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sophie Ann Shackley Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID5799267928

PECOS Enrollment IDI20260305003246

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Wi Hospitals & Clinics Authority

Acute Care Hospitals · Madison, WI

4/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number520098

Location600 Highland AvenueMadison, WI 53792 · Dane County

Emergency services

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE A MCCREARY MD

Family Medicine