Healthcare Provider Details

I. General information

NPI: 1811309271
Provider Name (Legal Business Name): JOANNA LAURA SHAFFER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA LAURA GRAEBER D.O.

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OLD MARLTON PIKE WEST SUITE 1
MARLTON NJ
08053
US

IV. Provider business mailing address

301 OLD MARLTON PIKE WEST SUITE 1
MARLTON NJ
08053
US

V. Phone/Fax

Practice location:
  • Phone: 856-988-9101
  • Fax: 856-988-0594
Mailing address:
  • Phone: 856-988-9101
  • Fax: 856-988-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB09948800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH83650
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS018863
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC2-0012309
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: