Provider Demographics
NPI:1740304591
Name:SHAFFER, CAITLIN STETSON JORDAN (MD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:STETSON JORDAN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:STETSON
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:430 E 63RD ST
Mailing Address - Street 2:APT 12F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7994
Mailing Address - Country:US
Mailing Address - Phone:757-647-4685
Mailing Address - Fax:
Practice Address - Street 1:430 E 63RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7918
Practice Address - Country:US
Practice Address - Phone:301-990-3190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272062-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine