Provider Demographics
NPI:1306675202
Name:SCHAFFER, ANDREA (ONC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:ONC
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SCHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ONC
Mailing Address - Street 1:10362 E SABLE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-8147
Mailing Address - Country:US
Mailing Address - Phone:646-322-7273
Mailing Address - Fax:
Practice Address - Street 1:10362 E SABLE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-8147
Practice Address - Country:US
Practice Address - Phone:646-322-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4172133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist