Provider Demographics
NPI:1851310320
Name:SHAFFER, ANGELA KAY (ATC, LMT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:KAY
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 E LACY CIR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8174
Mailing Address - Country:US
Mailing Address - Phone:386-574-4449
Mailing Address - Fax:
Practice Address - Street 1:10 DOGWOOD TRL
Practice Address - Street 2:SUITE D
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2443
Practice Address - Country:US
Practice Address - Phone:386-848-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40442225700000X
FLAL12512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer