Provider Demographics
NPI:1417207960
Name:SHAFFER, JILL (RD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TREE FARM RD # 4
Mailing Address - Street 2:BUILDING A 210
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-1435
Mailing Address - Country:US
Mailing Address - Phone:609-902-4480
Mailing Address - Fax:
Practice Address - Street 1:2 TREE FARM RD # 4
Practice Address - Street 2:BUILDING A 210
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1435
Practice Address - Country:US
Practice Address - Phone:609-902-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered