Provider Demographics
NPI:1932662004
Name:SHAFFER, EMILY MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MICHELLE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 OHIO DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-304-7234
Mailing Address - Fax:516-304-7269
Practice Address - Street 1:6 OHIO DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-304-7234
Practice Address - Fax:516-304-7269
Is Sole Proprietor?:No
Enumeration Date:2019-04-07
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program