Provider Demographics
NPI:1295187714
Name:SHAEFFER, SARAH (ATC, PES)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SHAEFFER
Suffix:
Gender:F
Credentials:ATC, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S. IRBY ST
Mailing Address - Street 2:SOUTH FLORENCE HGH SCHOOL
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505
Mailing Address - Country:US
Mailing Address - Phone:412-951-6564
Mailing Address - Fax:
Practice Address - Street 1:3200 S. IRBY ST
Practice Address - Street 2:SOUTH FLORENCE HGH SCHOOL
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505
Practice Address - Country:US
Practice Address - Phone:412-951-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC750172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker