Provider Demographics
NPI:1831126796
Name:SHAFER, GUADALUPE C (FNP)
Entity Type:Individual
Prefix:MS
First Name:GUADALUPE
Middle Name:C
Last Name:SHAFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19438 NEWTON PASS SQ
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6523
Mailing Address - Country:US
Mailing Address - Phone:703-407-7204
Mailing Address - Fax:703-407-7204
Practice Address - Street 1:19305 RUBY DR.
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3733
Practice Address - Country:US
Practice Address - Phone:703-407-7204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165767363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010200504Medicaid
VA010200512Medicaid
VA010200563Medicaid
VA010199964Medicaid
VA010200512Medicaid
VA007951N42Medicare ID - Type Unspecified