=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003818816
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STUART J SHAFER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2005
-----------------------------------------------------
Last Update Date | 02/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 37TH PL STE 201
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-492-7051
-----------------------------------------------------
Fax | 772-492-7048
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 37TH PL STE 201
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32960-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-492-7051
-----------------------------------------------------
Fax | 772-492-7048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | ME0072261
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------