Provider Demographics
NPI:1538124417
Name:SHAFFER, TODD C (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:C
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3664 DINSMORE CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4410
Mailing Address - Country:US
Mailing Address - Phone:614-527-7801
Mailing Address - Fax:614-340-3295
Practice Address - Street 1:85 MCNAUGHTEN RD
Practice Address - Street 2:STE 300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2174
Practice Address - Country:US
Practice Address - Phone:614-864-6644
Practice Address - Fax:614-340-3295
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P64607Medicare UPIN
SHPA19285Medicare ID - Type Unspecified