Provider Demographics
NPI:1841889151
Name:SHAFFER, AMY JO
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JO
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15718 ROUTE 8
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16438-9165
Mailing Address - Country:US
Mailing Address - Phone:814-664-0071
Mailing Address - Fax:814-835-2196
Practice Address - Street 1:105 CONCORD ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-1306
Practice Address - Country:US
Practice Address - Phone:814-790-2628
Practice Address - Fax:814-835-2196
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012945101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional