Provider Demographics
NPI:1871803338
Name:SHAFFER, MIRIAM
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
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 1:762 EMPIRE BLVD
Mailing Address - Street 2:APT 4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5633
Mailing Address - Country:US
Mailing Address - Phone:310-428-3057
Mailing Address - Fax:
Practice Address - Street 1:51 SAINT EDWARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2932
Practice Address - Country:US
Practice Address - Phone:718-855-6838
Practice Address - Fax:718-855-7032
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist