MEDICARE: SHAFFER HOLDINGS, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1982439097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAFFER HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	3863 HARRISON CROSSING LN
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-7414
Country	:	US
Telephone Number	:	574-225-2173
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 WESTERN BLVD STE F
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-9217
Country	:	US
Telephone Number	:	317-708-0798
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	JESSICA SHAFFER
Credential	:	NP-C
Telephone Number	:	574-225-2173

Provider Enumeration Date	:	09/06/2024
Last Update Date	:	09/06/2024

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