Healthcare Provider Details

I. General information

NPI: 1265813778
Provider Name (Legal Business Name): RONALD SHAFFER CST, CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 YONKERS ST
PLAINVIEW TX
79072-4859
US

IV. Provider business mailing address

1109 YONKER ST
PLAINVIEW TX
79072
US

V. Phone/Fax

Practice location:
  • Phone: 801-502-3333
  • Fax:
Mailing address:
  • Phone: 801-502-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number132081
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: