Healthcare Provider Details

I. General information

NPI: 1447946025
Provider Name (Legal Business Name): KERRI LEE SHAFFER BSN, RN, COA, OSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BRENNAN ST
HUNTINGTON NY
11743-5551
US

IV. Provider business mailing address

63 BRENNAN ST
HUNTINGTON NY
11743-5551
US

V. Phone/Fax

Practice location:
  • Phone: 516-216-0246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number804576-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: