Provider Demographics
NPI:1235502022
Name:KLEIN, NANCY SHAFFER
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:SHAFFER
Last Name:KLEIN
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 1:1501 ROBERT J CONLAN BLVD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3561
Mailing Address - Country:US
Mailing Address - Phone:321-723-8823
Mailing Address - Fax:321-723-9551
Practice Address - Street 1:1501 ROBERT J CONLAN BLVD NE STE 200
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3561
Practice Address - Country:US
Practice Address - Phone:321-723-8823
Practice Address - Fax:321-723-9551
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41456104100000X
FL146511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker