Provider Demographics
NPI:1992753321
Name:SHAFER, JAMES L (AUD, FAAA)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:SHAFER
Suffix:
Gender:M
Credentials:AUD, FAAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3618
Mailing Address - Country:US
Mailing Address - Phone:717-848-9871
Mailing Address - Fax:
Practice Address - Street 1:1776 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4628
Practice Address - Country:US
Practice Address - Phone:717-845-6321
Practice Address - Fax:717-845-6320
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT-000041-L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001649798 0001Medicaid
PAAT-000041-LOtherPA STATE LICENSE
PAAT-000041-LOtherPA STATE LICENSE
PA211658Medicare ID - Type Unspecified