MEDICARE: SHABREA AUSHAY SPAFFORD I

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
1	104100000X	Social Worker		IN

General Provider Information

NPI Number	:	1518815679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHABREA AUSHAY SPAFFORD I

Provider Business Mailing Address
First Line	:	8007 LAWRENCE WOODS CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-9403
Country	:	US
Telephone Number	:	317-296-5660
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 W PAZ DR APT A
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-4204
Country	:	US
Telephone Number	:	317-667-2069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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