Provider Demographics
NPI:1902919517
Name:SHAFER, JACALYN HOPE (MD)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:HOPE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 CENTRAL PARK W
Mailing Address - Street 2:#1FG
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7659
Mailing Address - Country:US
Mailing Address - Phone:212-579-4800
Mailing Address - Fax:212-579-9250
Practice Address - Street 1:320 CENTRAL PARK W
Practice Address - Street 2:#1FG
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7659
Practice Address - Country:US
Practice Address - Phone:212-579-4800
Practice Address - Fax:212-579-9250
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183406-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics