MEDICARE: BRENDA ELLEN SHAEFFER PT,DPT

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	174400000X	Specialist	17774	MD

General Provider Information

NPI Number	:	1811186299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA ELLEN SHAEFFER PT,DPT

Provider Business Mailing Address
First Line	:	2568A RIVA RD
Second Line	:	SUITE 303
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7445
Country	:	US
Telephone Number	:	410-266-2535
Fax Number	:	410-280-3804

Provider Business Practice Location Address
First Line	:	2568A RIVA RD
Second Line	:	SUITE 303
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7445
Country	:	US
Telephone Number	:	410-266-2535
Fax Number	:	410-280-3804

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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