Provider Demographics
NPI:1609024322
Name:SHAFFNER, ANDREW TYSON (MA SLP-CCC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:TYSON
Last Name:SHAFFNER
Suffix:
Gender:M
Credentials:MA SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MOSURE LN
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-6016
Mailing Address - Country:US
Mailing Address - Phone:530-514-0546
Mailing Address - Fax:
Practice Address - Street 1:1 GLENSHIRE LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-1072
Practice Address - Country:US
Practice Address - Phone:530-894-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP15424235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist