Provider Demographics
NPI:1962112789
Name:SHAFFER, JERRI ELLEN
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:ELLEN
Last Name:SHAFFER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WARWOOD AVE APT 318
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-7152
Mailing Address - Country:US
Mailing Address - Phone:304-215-6411
Mailing Address - Fax:
Practice Address - Street 1:1208 WARWOOD AVE APT 318
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-7152
Practice Address - Country:US
Practice Address - Phone:304-215-6411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1821206228Medicaid
WV1356607394Medicaid
WV125553494Medicaid