Healthcare Provider Details

I. General information

NPI: 1154219079
Provider Name (Legal Business Name): JAIDA MARIEE SHAFFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

IV. Provider business mailing address

801 VASSAR DR NE
ALBUQUERQUE NM
87106-2725
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-7687
  • Fax:
Mailing address:
  • Phone: 505-248-7687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2025-0130
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: