Provider Demographics
NPI:1992336713
Name:SHAFFER, SHANA LINSEY (NP)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:LINSEY
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:L
Other - Last Name:WINDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3239
Practice Address - Country:US
Practice Address - Phone:812-353-3333
Practice Address - Fax:812-323-8528
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28232247C363LF0000X
INF12191057363LF0000X
IN28232247A363LF0000X
IN71010258A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1000125008OtherANTHEM PTAN
IN300041346Medicaid
IN000001620994OtherANTHEM PTAN
INQ00426679OtherRAILROAD PTAN
IN1102370673OtherANTHEM PTAN