MEDICARE: GAIL BECKER SHAFNER RPT

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1982868444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL BECKER SHAFNER RPT

Provider Business Mailing Address
First Line	:	344 BRIDLE PATH LN
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-7927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 BRIDLE PATH LN
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-7927
Country	:	US
Telephone Number	:	386-589-3780
Fax Number	:

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

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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