Healthcare Provider Details

I. General information

NPI: 1124651377
Provider Name (Legal Business Name): AMANDA L SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 BUCKLEBURY RD
GREER SC
29651-7283
US

IV. Provider business mailing address

361 BUCKLEBURY RD
GREER SC
29651-7283
US

V. Phone/Fax

Practice location:
  • Phone: 864-534-3625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8158
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: