Provider Demographics
NPI:1013389329
Name:SHAFFER, MELISSA (ARNP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7383 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4527
Mailing Address - Country:US
Mailing Address - Phone:954-753-4492
Mailing Address - Fax:
Practice Address - Street 1:4943 N HARBOR ISLES DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5225
Practice Address - Country:US
Practice Address - Phone:954-625-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9302855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily