Provider Demographics
NPI:1649211863
Name:SHAFER, PAMELA A (MA)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:SHAFER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2751
Mailing Address - Country:US
Mailing Address - Phone:574-780-0619
Mailing Address - Fax:574-935-4315
Practice Address - Street 1:412 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2751
Practice Address - Country:US
Practice Address - Phone:574-780-0619
Practice Address - Fax:574-935-4315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002077A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist