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General NPI Number Information
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NPI Number | 1699265793
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Entity Type | Individual
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Provider Name | JAZMYNE SHIANN SHAFFER PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 3330 PEACH ST STE 106B
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City | ERIE
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State | PA
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Zip | 16508-2771
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Country | US
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Telephone | 814-877-5770
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Fax | 814-877-5771
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Provider Business Mailing Address
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Address Line | 3330 PEACH ST STE 106B
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City | ERIE
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State | PA
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Zip | 16508-2771
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Country | US
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Telephone | 814-877-5770
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Fax | 814-877-5771
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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 | OA004529
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License Number State | PA
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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 | MA059902
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License Number State | PA
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