Provider Demographics
NPI:1053066548
Name:SHAFER, JUDY (BCND)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:BCND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 CASTLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2957
Mailing Address - Country:US
Mailing Address - Phone:858-829-2875
Mailing Address - Fax:
Practice Address - Street 1:4290 CASTLEWOOD RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2957
Practice Address - Country:US
Practice Address - Phone:858-829-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath