Provider Demographics
NPI:1245785757
Name:SHAFFER, AMANDA LEE (MHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 ROUTE 203
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-2526
Mailing Address - Country:US
Mailing Address - Phone:185-429-7207
Mailing Address - Fax:
Practice Address - Street 1:6423 ROUTE 55
Practice Address - Street 2:
Practice Address - City:WINGDALE
Practice Address - State:NY
Practice Address - Zip Code:12594-1501
Practice Address - Country:US
Practice Address - Phone:845-350-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health