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1750104261 NPI number — SHELLY M SHAFFER

NPI Number: 1750104261
Health Care Provider/Practitioner: SHELLY M SHAFFER

Information about “1750104261” NPI (SHELLY M SHAFFER) exists in 1750104261 in HTML format HTML  |  1750104261 in plain Text format TXT  |  1750104261 in PDF (Portable Document Format) PDF  |  1750104261 in an XML format XML  formats.

NPI Number : 1750104261 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750104261",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHAFFER",
    "FirstName": "SHELLY",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BENEDETTO",
    "OtherFirstName": "SHELLY",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "2 ACADEMY ST RM 201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAYVILLE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14757-1050",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "716-753-4104",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "200 E 3RD ST STE 5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JAMESTOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14701-5433",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "716-661-8330",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/04/2024",
    "LastUpdateDate": "11/04/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "164W00000X",
        "TaxonomyName": "Licensed Practical Nurse",
        "LicenseNumber": "283470",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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