1528055837 NPI number — MRS. DONINE M SHAFFER OTR L CHT

Table of content: MRS. DONINE M SHAFFER OTR L CHT (NPI 1528055837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528055837 NPI number — MRS. DONINE M SHAFFER OTR L CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAFFER
Provider First Name:
DONINE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR L CHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528055837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 173132
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33672-1132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-877-8811
Provider Business Mailing Address Fax Number:
717-918-5745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 WALNUT BOTTOM RD STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-877-8811
Provider Business Practice Location Address Fax Number:
717-918-5745
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OC002641L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5451130001 . This is a "HEALTHNOW NY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 683986 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2330572 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 76210 . This is a "HEALTH AMERICA COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02038201 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 670001383 . This is a "PALMETTO RR MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7176107 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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