Provider Demographics
NPI:1043826969
Name:SCHAEFFER, JOHN PAUL (HIS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N WITCHDUCK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1947
Mailing Address - Country:US
Mailing Address - Phone:833-687-8324
Mailing Address - Fax:757-222-5991
Practice Address - Street 1:600 N WITCHDUCK RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1947
Practice Address - Country:US
Practice Address - Phone:833-687-8324
Practice Address - Fax:757-222-5991
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB201502220146N00000X
VA2101002458237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2101002458OtherVIRGINIA DEPARTMENT OF PROFESSIONAL AND OCCUPATIONAL REGULATION