| Sandra Shaffer | |
|
3475 Omro Rd Ste 400 Oshkosh WI 54904-7126 | |
| (920) 203-7565 | |
| Not Available |
| Full Name | Sandra Shaffer |
|---|---|
| Speciality | Social Worker |
| Location | 3475 Omro Rd Ste 400, Oshkosh, Wisconsin |
| Authorized Official Name and Position | Sandra Marie Shaffer (THERAPIST/OWNER) |
| Authorized Official Contact | 9208960189 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sandra Shaffer 303 Watson St Ste D Ripon WI 54971-1516 Ph: (920) 896-0189 | Sandra Shaffer 3475 Omro Rd Ste 400 Oshkosh WI 54904-7126 Ph: (920) 203-7565 |
| NPI Number | 1184230351 |
|---|---|
| Provider Enumeration Date | 09/22/2020 |
| Last Update Date | 11/10/2020 |
| Certification Date | 11/10/2020 |
| Medicare PECOS PAC ID | 8224448253 |
|---|---|
| Medicare Enrollment ID | O20201103001980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184230351 | NPI | - | NPPES |
| 1184230351 | Other | WI | NPI-TYPE 2 |
| 1427228436 | Other | WI | NPI |
| 12349916 | Other | CAQH | |
| 100102138 | Medicaid | WI |
| Provider Name | Sandra Marie Shaffer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427228436 PECOS PAC ID: 9133539166 Enrollment ID: I20201103002134 |
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