Provider Demographics
NPI:1972235901
Name:SHAFFER, RAVEN MONET
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:MONET
Last Name:SHAFFER
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 1:4262 E CAPITOL ST NE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4487
Mailing Address - Country:US
Mailing Address - Phone:202-436-6827
Mailing Address - Fax:
Practice Address - Street 1:4000 MASSACHUSETTS AVE NW APT 1631
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-5139
Practice Address - Country:US
Practice Address - Phone:202-883-9866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant