Provider Demographics
NPI:1497827158
Name:SHAFFER, LISHIANA S (MD)
Entity Type:Individual
Prefix:
First Name:LISHIANA
Middle Name:S
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISHIANA
Other - Middle Name:NICOL-MARIA
Other - Last Name:SOLANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:364 SE 8TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4249
Mailing Address - Country:US
Mailing Address - Phone:503-681-4145
Mailing Address - Fax:503-681-4146
Practice Address - Street 1:364 SE 8TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4249
Practice Address - Country:US
Practice Address - Phone:503-681-4145
Practice Address - Fax:503-681-4146
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD153333207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A821810Medicaid
00A821810Medicare ID - Type Unspecified
CA00A821810Medicaid