Provider Demographics
NPI:1588177182
Name:SCHAEFFER, KELSEY ALEXANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALEXANDRA
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2302 NORTH BLVD W STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-8923
Mailing Address - Country:US
Mailing Address - Phone:407-299-7333
Mailing Address - Fax:863-422-5855
Practice Address - Street 1:2302 NORTH BLVD W STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-8923
Practice Address - Country:US
Practice Address - Phone:407-299-7333
Practice Address - Fax:863-422-5855
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110778363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant