Healthcare Provider Details

I. General information

NPI: 1124943006
Provider Name (Legal Business Name): IZOBEL SHAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4198
US

IV. Provider business mailing address

1543 UNION CENTER MAINE HWY
ENDICOTT NY
13760-1338
US

V. Phone/Fax

Practice location:
  • Phone: 607-798-5255
  • Fax:
Mailing address:
  • Phone: 607-341-1520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number031318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: