Provider Demographics
NPI:1457668303
Name:SHAFER, SHELLY (DPT)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:CLIFTON SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:14432-1041
Mailing Address - Country:US
Mailing Address - Phone:315-462-3588
Mailing Address - Fax:315-906-0058
Practice Address - Street 1:210 CLIFTON SPRINGS PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1041
Practice Address - Country:US
Practice Address - Phone:315-462-3588
Practice Address - Fax:315-906-0058
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032880-1225100000X
2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic