Provider Demographics
NPI:1902034606
Name:SHAFFER, MONICA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:LYNN
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 MARION SQ
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1367
Mailing Address - Country:US
Mailing Address - Phone:304-367-0387
Mailing Address - Fax:304-367-9470
Practice Address - Street 1:51 SOUTHLAND DR
Practice Address - Street 2:SUITE 3200
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2244
Practice Address - Country:US
Practice Address - Phone:304-333-8385
Practice Address - Fax:304-333-8349
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant