Provider Demographics
NPI:1821581679
Name:SHAFFETT, DAKOTA SCOTT
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:SCOTT
Last Name:SHAFFETT
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:PO BOX 139
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0139
Mailing Address - Country:US
Mailing Address - Phone:207-255-0996
Mailing Address - Fax:207-255-8748
Practice Address - Street 1:14 STEVES LN
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654-5045
Practice Address - Country:US
Practice Address - Phone:207-255-0996
Practice Address - Fax:207-255-8748
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
LA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician