Provider Demographics
NPI:1508211285
Name:LINDSAY-SHAFFER, ANDREA (BS SUDC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LINDSAY-SHAFFER
Suffix:
Gender:F
Credentials:BS SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 E EDGECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4309
Mailing Address - Country:US
Mailing Address - Phone:801-664-2464
Mailing Address - Fax:
Practice Address - Street 1:1630 E EDGECLIFF DR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-4309
Practice Address - Country:US
Practice Address - Phone:801-664-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)