Provider Demographics
NPI:1427025873
Name:SHAFER, SHIRLEY (SLP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:SILVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4502
Mailing Address - Country:US
Mailing Address - Phone:315-449-2208
Mailing Address - Fax:315-362-5120
Practice Address - Street 1:1603 COURT ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-1834
Practice Address - Country:US
Practice Address - Phone:315-455-7591
Practice Address - Fax:315-455-1087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist