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General NPI Number Information
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NPI Number | 1356777353
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Entity Type | Individual
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Provider Name | THERESA ANN SHAFER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/23/2013
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 479 THOMAS JONES WAY SUITE 300
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City | EXTON
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State | PA
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Zip | 19341
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Country | US
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Telephone | 267-582-6467
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Fax | 215-615-1294
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Provider Business Mailing Address
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Address Line | 479 THOMAS JONES WAY SUITE 300
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City | EXTON
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State | PA
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Zip | 19341
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Country | US
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Telephone | 267-582-6467
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Fax | 215-615-1294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA056359
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00347500
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License Number State | NJ
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