Healthcare Provider Details

I. General information

NPI: 1043826969
Provider Name (Legal Business Name): JOHN PAUL SCHAEFFER HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WITCHDUCK RD STE 103
VIRGINIA BEACH VA
23462-1947
US

IV. Provider business mailing address

600 N WITCHDUCK RD STE 103
VIRGINIA BEACH VA
23462-1947
US

V. Phone/Fax

Practice location:
  • Phone: 833-687-8324
  • Fax: 757-222-5991
Mailing address:
  • Phone: 833-687-8324
  • Fax: 757-222-5991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB201502220
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101002458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: