Provider Demographics
NPI:1841975455
Name:SHAFFER, MARY FAYE
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:FAYE
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 1:4533 STEPHENS CIR NW APT 108
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3626
Mailing Address - Country:US
Mailing Address - Phone:234-347-0136
Mailing Address - Fax:
Practice Address - Street 1:4533 STEPHENS CIR NW APT 108
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3626
Practice Address - Country:US
Practice Address - Phone:234-347-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSL892823347C00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle