Provider Demographics
NPI:1346238003
Name:SHEAFFER, CAROLYN (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:SHEAFFER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1371
Mailing Address - Country:US
Mailing Address - Phone:301-334-8171
Mailing Address - Fax:301-334-1807
Practice Address - Street 1:311 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1371
Practice Address - Country:US
Practice Address - Phone:301-334-8171
Practice Address - Fax:301-334-1807
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133781363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000418Medicaid
MD405518700Medicaid
MDP00179112Medicare PIN
MDQ24078Medicare UPIN
WV3810000418Medicaid