Individual
THOMAS G SHAFER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NPP-BC
Contact information
Practice address
350 NEW CAMPUS DR, SUNY COLLEGE AT BROCKPORT, BROCKPORT, NY 15520
(585) 395-2207
Mailing address
243 WILLOWBROOKE DR, BROCKPORT, NY 14420
(585) 953-6405
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
586940
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401602
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
401602
NURSE PRACTITIONER- PSYCHIATRY LICENSE NUMBER
NY
01
—
586940
RN LICENSE
NY
Enumeration date
05/11/2012
Last updated
10/22/2014
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