Provider Demographics
NPI:1518643766
Name:SHAFFER, KACEY NICOLLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KACEY
Middle Name:NICOLLE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 ARENDELL ST STE G
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2866
Mailing Address - Country:US
Mailing Address - Phone:252-247-3257
Mailing Address - Fax:
Practice Address - Street 1:4218 ARENDELL ST STE G
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2866
Practice Address - Country:US
Practice Address - Phone:252-247-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30001949231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist