MEDICARE: RAVEN MONET 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1972235901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN MONET SHAFFER

Provider Business Mailing Address
First Line	:	4262 E CAPITOL ST NE APT 203
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-4487
Country	:	US
Telephone Number	:	202-436-6827
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 MASSACHUSETTS AVE NW APT 1631
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-5139
Country	:	US
Telephone Number	:	202-883-9866
Fax Number	:

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

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	06/28/2022

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Directions to “ RAVEN MONET SHAFFER ” Practice Location

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