Provider Demographics
NPI:1760441281
Name:SHAEFFER, GAIL S (ANP C)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:S
Last Name:SHAEFFER
Suffix:
Gender:F
Credentials:ANP C
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:S
Other - Last Name:SHAEFFER-MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN ANP C
Mailing Address - Street 1:4808 BUTTONBUSH DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712
Mailing Address - Country:US
Mailing Address - Phone:919-618-3114
Mailing Address - Fax:
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:BLDG 700 TRIANGLE HEART ASSOC
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704
Practice Address - Country:US
Practice Address - Phone:919-220-5510
Practice Address - Fax:919-220-6536
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900115207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
S70590Medicare UPIN