MEDICARE: MR. WILLIAM MICHAEL SHAFNACKER PAC MHP

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	363A00000X	Physician Assistant	001195	CT
2	363A00000X	Physician Assistant	789	MA

General Provider Information

NPI Number	:	1518943810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM MICHAEL SHAFNACKER PAC MHP

Provider Business Mailing Address
First Line	:	28 WOODLAND DR
Second Line	:
City	:	CLINTON
State	:	CT
Zip	:	06413-1301
Country	:	US
Telephone Number	:	860-669-4209
Fax Number	:	860-669-4209

Provider Business Practice Location Address
First Line	:	6 BUSINESS PARK DR STE 302
Second Line	:	STONY CREEK URGENT CARE
City	:	BRANFORD
State	:	CT
Zip	:	06405-2988
Country	:	US
Telephone Number	:	203-483-4580
Fax Number	:	203-483-4581

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	01/10/2012

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