MEDICARE: DR. SCOTT SHAFFER MD

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	2084P0800X	Psychiatry Physician	256743	NY

General Provider Information

NPI Number	:	1588727630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT SHAFFER MD

Provider Business Mailing Address
First Line	:	3340 BAINBRIDGE AVE
Second Line	:	OFFICE 203
City	:	BRONX
State	:	NY
Zip	:	10467-2802
Country	:	US
Telephone Number	:	718-696-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 MORRIS PARK AVENUE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-0000
Country	:	US
Telephone Number	:	718-839-7015
Fax Number	:

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/13/2015

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