Provider Demographics
NPI:1629783345
Name:SHAFFER, JESSICA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:571 ALGER ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15207-1043
Mailing Address - Country:US
Mailing Address - Phone:570-772-7019
Mailing Address - Fax:
Practice Address - Street 1:571 ALGER ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15207-1043
Practice Address - Country:US
Practice Address - Phone:570-772-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN005967133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered