MEDICARE: AMANDA MICHELLE SHAFER CSW-PIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4883	SD
2	1041C0700X	Clinical Social Worker	6037	SD

General Provider Information

NPI Number	:	1700344926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MICHELLE SHAFER CSW-PIP

Provider Business Mailing Address
First Line	:	15543 LONESOME DOVE ST
Second Line	:
City	:	BOX ELDER
State	:	SD
Zip	:	57719-8139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7272 WURZBACH RD STE 601
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:	210-615-3483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	01/06/2025

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