Healthcare Provider Details

I. General information

NPI: 1811678022
Provider Name (Legal Business Name): NATALIE KAITLYN SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 VAN NUYS BLVD
VAN NUYS CA
91405-3937
US

IV. Provider business mailing address

12431 HILLSIDE DR
MOORPARK CA
93021-2756
US

V. Phone/Fax

Practice location:
  • Phone: 818-376-0134
  • Fax:
Mailing address:
  • Phone: 805-657-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW133306
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: