Provider Demographics
NPI:1912328790
Name:SHAFFER, CHAUNTEL (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CHAUNTEL
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JANE ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5211
Mailing Address - Country:US
Mailing Address - Phone:845-705-1054
Mailing Address - Fax:
Practice Address - Street 1:40 DEVEREUX WAY
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-2268
Practice Address - Country:US
Practice Address - Phone:845-758-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY58 020932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist