Provider Demographics
NPI:1891798047
Name:SHAFFER, CYNTHIA FERNANDEZ (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:FERNANDEZ
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:NP-C
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 891
Mailing Address - Street 2:
Mailing Address - City:COLLEGEDALE
Mailing Address - State:TN
Mailing Address - Zip Code:37315-0891
Mailing Address - Country:US
Mailing Address - Phone:423-778-9701
Mailing Address - Fax:
Practice Address - Street 1:9309 APISON PIKE
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4340
Practice Address - Country:US
Practice Address - Phone:423-778-9701
Practice Address - Fax:423-778-9713
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5567207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5567OtherAPN LICENSE
TNS87172Medicare UPIN