MEDICARE: SELENA MARIE SHAFFER

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	S.2309917	OH

General Provider Information

NPI Number	:	1932985413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA MARIE SHAFFER

Provider Business Mailing Address
First Line	:	1865 N RIDGE RD E STE A
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3359
Country	:	US
Telephone Number	:	440-324-5701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 N RIDGE RD E STE A
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3359
Country	:	US
Telephone Number	:	440-324-5701
Fax Number	:

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

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	05/06/2026

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