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General NPI Number Information
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NPI Number | 1518943810
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Entity Type | Individual
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Provider Name | WILLIAM MICHAEL SHAFNACKER PAC MHP
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 6 BUSINESS PARK DR STE 302 STONY CREEK URGENT CARE
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City | BRANFORD
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State | CT
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Zip | 06405-2988
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Country | US
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Telephone | 203-483-4580
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Fax | 203-483-4581
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Provider Business Mailing Address
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Address Line | 28 WOODLAND DR
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City | CLINTON
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State | CT
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Zip | 06413-1301
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Country | US
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Telephone | 860-669-4209
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Fax | 860-669-4209
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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 | 001195
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 789
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License Number State | MA
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