Provider Demographics
NPI:1972572147
Name:SHAFER, SYLVIA DARLENE (PA C)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:DARLENE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15223 N 87TH ST
Mailing Address - Street 2:#110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2639
Mailing Address - Country:US
Mailing Address - Phone:480-682-4100
Mailing Address - Fax:480-304-3553
Practice Address - Street 1:15223 N 87TH ST
Practice Address - Street 2:#110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2639
Practice Address - Country:US
Practice Address - Phone:480-682-4100
Practice Address - Fax:480-304-3553
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0340363A00000X
AZ5402363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ913783Medicaid
AZ913783Medicaid
AZZ182202Medicare PIN
S95912Medicare UPIN