Healthcare Provider Details

I. General information

NPI: 1932662004
Provider Name (Legal Business Name): EMILY MICHELLE SHAFFER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NW 12TH AVE # 4071
MIAMI FL
33136-1087
US

IV. Provider business mailing address

1600 NW 10TH AVE
MIAMI FL
33136-1015
US

V. Phone/Fax

Practice location:
  • Phone: 304-614-6141
  • Fax:
Mailing address:
  • Phone: 305-243-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberOS22997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: