Provider Demographics
NPI:1568424638
Name:SHAEFFER, TIMOTHY JASON
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JASON
Last Name:SHAEFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1859
Mailing Address - Country:US
Mailing Address - Phone:617-799-8194
Mailing Address - Fax:617-242-2308
Practice Address - Street 1:BUILDING 5, CHARLESTOWN NAVY YARD
Practice Address - Street 2:USS CONSTITUTION
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1797
Practice Address - Country:US
Practice Address - Phone:617-799-8194
Practice Address - Fax:617-242-2308
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman