Provider Demographics
NPI:1003818816
Name:SHAFER, STUART J (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:J
Last Name:SHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1040 37TH PL
Mailing Address - Street 2:STE 201
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4818
Mailing Address - Country:US
Mailing Address - Phone:772-492-7051
Mailing Address - Fax:772-492-7048
Practice Address - Street 1:1040 37TH PL STE 201
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4818
Practice Address - Country:US
Practice Address - Phone:772-492-7051
Practice Address - Fax:772-492-7048
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00722612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21022OtherBC BS
FL252717100Medicaid
FL21022OtherBC BS
FL0167320001Medicare NSC
FL21022Medicare PIN