Healthcare Provider Details

I. General information

NPI: 1578039061
Provider Name (Legal Business Name): JACQUELINE A SHAFFER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4139 BOARDMAN CANFIELD RD STE 1
CANFIELD OH
44406-9034
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 330-702-1372
  • Fax: 330-702-1287
Mailing address:
  • Phone: 330-729-8145
  • Fax: 330-965-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.023891
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: