Provider Demographics
NPI:1174770861
Name:SHAFFER, TANI G (PHD)
Entity type:Individual
Prefix:DR
First Name:TANI
Middle Name:G
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 FAIR OAKS BLVD # 1885
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-9900
Mailing Address - Country:US
Mailing Address - Phone:916-671-4468
Mailing Address - Fax:
Practice Address - Street 1:6929 FAIR OAKS BLVD # 1885
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-9900
Practice Address - Country:US
Practice Address - Phone:916-671-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical