| Doctor Name: | THOMAS G SHAFER |
| NPI Number: | 1205195278 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NPP-BC |
| License Number: | 586940 |
| Business Practice Address: | 350 New Campus Dr Suny College At Brockport Brockport, NY - 15520 |
| Business Phone Number: | 5853952207 |
| Business Fax Number: | |
| Mailing Address: | 243 Willowbrooke Dr, BROCKPORT |
| State: | NY |
| Postal Code: | 14420 |
| Phone Number: | 5859536405 |
| Fax Number: | |
| NPI Enumeration Date: | 05/11/2012 |
| NPI Last Update Date: | 10/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 586940 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |