Provider Demographics
NPI:1417527953
Name:SHAFER, TIFFANY
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SHAFER
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 1:291 MEADVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAVISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26142-8131
Mailing Address - Country:US
Mailing Address - Phone:304-580-8376
Mailing Address - Fax:
Practice Address - Street 1:418 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-9549
Practice Address - Country:US
Practice Address - Phone:740-374-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist