Healthcare Provider Details

I. General information

NPI: 1932033198
Provider Name (Legal Business Name): SHELBY SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 W ANKLAM RD
TUCSON AZ
85745-2632
US

IV. Provider business mailing address

1780 W ANKLAM RD
TUCSON AZ
85745-2632
US

V. Phone/Fax

Practice location:
  • Phone: 520-975-8700
  • Fax:
Mailing address:
  • Phone: 800-449-1241
  • Fax: 520-620-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number803808
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: