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NPI Code Detail

MEDICARE: DR. LISA BROOKE SHAFFER PSYD

MEDICARE: DR. LISA BROOKE SHAFFER PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY0498NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033285572
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA BROOKE SHAFFER PSYD
Provider Business Mailing Address
First Line : 1489 W WARM SPRINGS RD
Second Line : STE 110
City : HENDERSON
State : NV
Zip : 89014-7367
Country : US
Telephone Number : 702-806-8618
Fax Number : 800-567-4105
Provider Business Practice Location Address
First Line : 1489 W WARM SPRINGS RD
Second Line : STE 110
City : HENDERSON
State : NV
Zip : 89014-7367
Country : US
Telephone Number : 702-806-8618
Fax Number : 800-567-4105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/27/2006
Last Update Date : 06/11/2020

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