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General NPI Number Information
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NPI Number | 1164637161
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Entity Type | Organization
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Legal Business Name | SHAYNA YEDRA-SCHAEFER
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Dates
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Enumeration Date | 05/12/2007
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 1717 WILMOORE DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4128
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Country | US
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Telephone | 505-720-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 WILMOORE DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4128
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Country | US
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Telephone | 505-720-7702
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Fax |
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | MRS. SHAYNA LEE SCHAEFER
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Credential | LISW
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Telephone | 505-720-7702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I-06002
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License Number State | NM
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