Provider Demographics
NPI:1861782104
Name:SHAFFER, CHARLOTTE MARY
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARY
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 1:34327 US HWY 31 NORTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:STAPLETON
Mailing Address - State:AL
Mailing Address - Zip Code:36578
Mailing Address - Country:US
Mailing Address - Phone:251-272-2920
Mailing Address - Fax:251-937-7009
Practice Address - Street 1:34327 US HWY 31 NORTH
Practice Address - Street 2:
Practice Address - City:STAPLETON
Practice Address - State:AL
Practice Address - Zip Code:36578
Practice Address - Country:US
Practice Address - Phone:251-272-2920
Practice Address - Fax:251-937-7009
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL63-1259902332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies