Provider Demographics
NPI:1194537308
Name:SHAFER, SHARALYN (CLC)
Entity type:Individual
Prefix:
First Name:SHARALYN
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 STEAMBOAT LOOP E
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-4833
Mailing Address - Country:US
Mailing Address - Phone:509-906-2486
Mailing Address - Fax:
Practice Address - Street 1:1805 SE SALMONBERRY RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-5922
Practice Address - Country:US
Practice Address - Phone:509-906-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
361222174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN