Provider Demographics
NPI:1427146166
Name:SCHAFFER, JUDITH PAMELA (DO)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:PAMELA
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12555 PALM RD
Mailing Address - Street 2:
Mailing Address - City:N MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181
Mailing Address - Country:US
Mailing Address - Phone:305-981-7654
Mailing Address - Fax:
Practice Address - Street 1:1750 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3017
Practice Address - Country:US
Practice Address - Phone:305-949-6202
Practice Address - Fax:954-262-3993
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370130100Medicaid
FL370130100Medicaid
FLB0748VMedicare ID - Type Unspecified