Healthcare Provider Details

I. General information

NPI: 1225605785
Provider Name (Legal Business Name): JONATHAN M SHAFER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JONATHAN SHAFER DO

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 INDIANA ST
SEWARD PA
15954-2055
US

IV. Provider business mailing address

640 KOLTER DR
INDIANA PA
15701-3570
US

V. Phone/Fax

Practice location:
  • Phone: 814-446-5695
  • Fax: 814-446-4209
Mailing address:
  • Phone: 724-835-7171
  • Fax: 724-357-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS023660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: