Provider Demographics
NPI:1457869984
Name:SHIFFER, GEORGE ROBERT
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ROBERT
Last Name:SHIFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-3015
Mailing Address - Country:US
Mailing Address - Phone:585-344-4404
Mailing Address - Fax:
Practice Address - Street 1:64 WALNUT ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-3015
Practice Address - Country:US
Practice Address - Phone:585-344-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool