Provider Demographics
NPI:1154075752
Name:SHAFFER, LILLIAN SHADE (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:SHADE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:SHADE
Other - Last Name:EPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2005 EVANS LN NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-2057
Mailing Address - Country:US
Mailing Address - Phone:662-473-6293
Mailing Address - Fax:
Practice Address - Street 1:117 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-3511
Practice Address - Country:US
Practice Address - Phone:256-291-8877
Practice Address - Fax:256-500-9311
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2025-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363AM0700X
AL2600363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical