Healthcare Provider Details

I. General information

NPI: 1033064183
Provider Name (Legal Business Name): MATTHEW SHAFFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 E WARNER RD APT 2058
PHOENIX AZ
85044-3348
US

IV. Provider business mailing address

4727 E WARNER RD APT 2058
PHOENIX AZ
85044-3348
US

V. Phone/Fax

Practice location:
  • Phone: 586-718-9269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-50624
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: