1972572147 NPI number — MS. SYLVIA DARLENE SHAFER PA C

Table of content: MS. SYLVIA DARLENE SHAFER PA C (NPI 1972572147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972572147 NPI number — MS. SYLVIA DARLENE SHAFER PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAFER
Provider First Name:
SYLVIA
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA C
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:
1972572147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15223 N 87TH ST
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85260-2639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-682-4100
Provider Business Mailing Address Fax Number:
480-304-3553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15223 N 87TH ST
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85260-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-682-4100
Provider Business Practice Location Address Fax Number:
480-304-3553
Provider Enumeration Date:
03/17/2006

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: 363A00000X , with the licence number:  0340 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 5402 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 913783 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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