Teresa Marie Shaffer, CNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

APRN.CNP.021730 Issued in OH

Practice address

987 Boardman Canfield Rd
Boardman, OH 44512-4222

Phone

(330) 271-8589

Fax

(330) 965-9325

NPI assigned

Sep 20, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optima Dermatology LLCGroup PAC ID 3971561648, 74 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tshaffer@advdermatology.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optima Dermatology LLC

  • Dermatology Physician
  • Boardman, OH
  • NPI 1831187764

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Advanced Dermatology and Skin Cancer Center

  • Clinical Medical Laboratory
  • Boardman, OH
  • NPI 1497912893
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707177600000",
    "number": "1770092900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAMPSHIRE AVE STE 2",
            "city": "PORTSMOUTH",
            "state": "NH",
            "postal_code": "038012864",
            "telephone_number": "802-909-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 BOARDMAN CANFIELD RD",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445124222",
            "telephone_number": "330-271-8589",
            "fax_number": "330-965-9325"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2525 E State St",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OH",
            "postal_code": "444609301",
            "country_code": "US",
            "telephone_number": "330-271-8614",
            "fax_number": "330-525-9008",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2223 Niles Cortland Rd SE",
            "address_purpose": "LOCATION",
            "city": "Warren",
            "state": "OH",
            "postal_code": "444843043",
            "country_code": "US",
            "telephone_number": "330-965-8760",
            "fax_number": "330-469-9706",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1039 Boardman Canfield Rd",
            "address_purpose": "LOCATION",
            "city": "Boardman",
            "state": "OH",
            "postal_code": "445124211",
            "country_code": "US",
            "telephone_number": "330-271-8589",
            "fax_number": "330-965-9325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "TERESA",
        "middle_name": "MARIE",
        "name_prefix": "Miss",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-09-20",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.021730",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry E Semivan, MSED, LPCC
• Manu Sethi, M.D.
• David Shaffer
• Lauren Shaffer, CDCA
• Lawrence A Shaffer, M.D.
• Kruti Munir Shah, MD
• Muhammad Usman Shaikh, M.D.
• Kathleen Marie Shannon, LISW
• Patrick L. Shannon, M.D.
• Norhan Sharaf, DO

• Adult Health Nurse Practitioner in Boardman, OH
• Providers in Boardman, OH by specialty
• Adult Health Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.