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General NPI Number Information
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NPI Number | 1851310320
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Entity Type | Individual
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Provider Name | ANGELA KAY SHAFFER ATC, LMT
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/31/2014
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Provider Practice Location Address
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Address Line | 10 DOGWOOD TRL SUITE D
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City | DEBARY
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State | FL
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Zip | 32713-2443
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Country | US
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Telephone | 386-848-5528
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Fax |
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Provider Business Mailing Address
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Address Line | 758 E LACY CIR
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City | DELTONA
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State | FL
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Zip | 32725-8174
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Country | US
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Telephone | 386-574-4449
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 40442
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL1251
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License Number State | FL
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