Provider Demographics
NPI:1225799711
Name:SHAFER, SANDRA A
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:SHAFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2329
Mailing Address - Country:US
Mailing Address - Phone:704-245-4479
Mailing Address - Fax:
Practice Address - Street 1:444 FOREST LN
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-2329
Practice Address - Country:US
Practice Address - Phone:704-245-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker