Provider Demographics
NPI:1386901007
Name:SHAFFER, PRIYA DEVI (DDS)
Entity type:Individual
Prefix:MISS
First Name:PRIYA
Middle Name:DEVI
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 MAIN ST # 40
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6588
Mailing Address - Country:US
Mailing Address - Phone:651-674-4811
Mailing Address - Fax:
Practice Address - Street 1:6041 MAIN ST # 40
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6588
Practice Address - Country:US
Practice Address - Phone:651-674-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4437122300000X
MND13091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist