Healthcare Provider Details

I. General information

NPI: 1780351908
Provider Name (Legal Business Name): SARAH ELIZABETH SHAFFER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 FAIRMOUNT AVE
FORT WORTH TX
76104-4215
US

IV. Provider business mailing address

601 OMEGA DR STE 208
ARLINGTON TX
76014-2075
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-5288
  • Fax: 817-338-0927
Mailing address:
  • Phone: 817-465-5881
  • Fax: 817-394-6294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14732
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: