Healthcare Provider Details

I. General information

NPI: 1831684661
Provider Name (Legal Business Name): SHAE LEE NICOLE SHAFFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

1111 PEPPER HILL RD
GREENSBORO NC
27407-2837
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-2840
  • Fax:
Mailing address:
  • Phone: 828-443-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5010637
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: