Healthcare Provider Details

I. General information

NPI: 1558366153
Provider Name (Legal Business Name): CARRIE SHAFFER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

1711 E PORTER AVE
CHESTERTON IN
46304-9113
US

V. Phone/Fax

Practice location:
  • Phone: 219-776-1282
  • Fax:
Mailing address:
  • Phone: 219-776-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4135
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025023431
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6346
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002783A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number104692
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: