Provider Demographics
NPI:1902492572
Name:SHAFFER, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SISSONVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25320
Mailing Address - Country:US
Mailing Address - Phone:681-427-5078
Mailing Address - Fax:
Practice Address - Street 1:58 CAYTON RD
Practice Address - Street 2:
Practice Address - City:SISSONVILLE
Practice Address - State:WV
Practice Address - Zip Code:25320
Practice Address - Country:US
Practice Address - Phone:681-427-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant