Provider Demographics
NPI:1780852319
Name:HAFNER, SHAUN CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:CHARLES
Last Name:HAFNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8577 SUDLEY RD
Mailing Address - Street 2:SUITE-A
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3810
Mailing Address - Country:US
Mailing Address - Phone:703-368-7166
Mailing Address - Fax:703-368-5103
Practice Address - Street 1:8577 SUDLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3810
Practice Address - Country:US
Practice Address - Phone:703-368-7166
Practice Address - Fax:703-368-5103
Is Sole Proprietor?:No
Enumeration Date:2008-02-17
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301004213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACC5940OtherRAILROAD MEDICARE GROUP
VA0442570004Medicare NSC
VA186715Medicare PIN
VA0442570002Medicare NSC
VA0442570001Medicare NSC
VAC01127Medicare PIN
VAC02868Medicare PIN