Provider Demographics
NPI:1699265793
Name:SHAFFER, JAZMYNE SHIANN (PA-C)
Entity type:Individual
Prefix:
First Name:JAZMYNE
Middle Name:SHIANN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAZMYNE
Other - Middle Name:SHIANN
Other - Last Name:SASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3330 PEACH ST STE 106B
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2771
Mailing Address - Country:US
Mailing Address - Phone:814-877-5770
Mailing Address - Fax:814-877-5771
Practice Address - Street 1:3330 PEACH ST STE 106B
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2771
Practice Address - Country:US
Practice Address - Phone:814-877-5770
Practice Address - Fax:814-877-5771
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004529363A00000X
PAMA059902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant