Healthcare Provider Details

I. General information

NPI: 1407931405
Provider Name (Legal Business Name): C. SHAFFIA LAUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 KENTUCKY ST
LAWRENCE KS
66044
US

IV. Provider business mailing address

1025 KENTUCKY ST
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 785-841-1243
  • Fax: 785-841-1243
Mailing address:
  • Phone: 785-841-1243
  • Fax: 785-841-1243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0418885
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number04-18885
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: