Provider Demographics
NPI:1558726265
Name:SHAFFRON, AMY E (M/SLP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:SHAFFRON
Suffix:
Gender:F
Credentials:M/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 OCEAN POINT DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4426
Mailing Address - Country:US
Mailing Address - Phone:304-320-7395
Mailing Address - Fax:
Practice Address - Street 1:6927 OLD SEWARD HWY STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518
Practice Address - Country:US
Practice Address - Phone:907-345-0050
Practice Address - Fax:907-344-5103
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007410235Z00000X
AK124026235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978218Medicaid
VA4978218Medicaid