Provider Demographics
NPI:1588788855
Name:SHOFFNER, MARY LYNDALL
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNDALL
Last Name:SHOFFNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EASTWAY LN
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3704
Mailing Address - Country:US
Mailing Address - Phone:336-229-0603
Mailing Address - Fax:
Practice Address - Street 1:116 EASTWAY LN
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3704
Practice Address - Country:US
Practice Address - Phone:336-229-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner