Provider Demographics
NPI:1316778913
Name:SCHAFFER-SMITH, STARR (PRSS-INT-5202)
Entity type:Individual
Prefix:
First Name:STARR
Middle Name:
Last Name:SCHAFFER-SMITH
Suffix:
Gender:F
Credentials:PRSS-INT-5202
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9698
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060-9698
Mailing Address - Country:US
Mailing Address - Phone:909-277-0782
Mailing Address - Fax:
Practice Address - Street 1:1161 S LOOP RD BLDG B
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4765
Practice Address - Country:US
Practice Address - Phone:775-751-6992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPRSS-INT-5202175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist