Healthcare Provider Details

I. General information

NPI: 1144068859
Provider Name (Legal Business Name): NEAL JACOB SHAFFER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8844 BENSON RD
LYNDEN WA
98264-9787
US

IV. Provider business mailing address

8844 BENSON RD
LYNDEN WA
98264-9787
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA70078546
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: