Susan L Shafer, RN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

10912258 Issued in NM

Practice address

4701 Montgomery Blvd NE Ste 105
Albuquerque, NM 87109-1219

Phone

(505) 727-6797

Fax

(505) 727-9979

NPI assigned

Nov 21, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511222400000",
    "number": "1770097172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 MONTGOMERY BLVD NE STE 105",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091219",
            "telephone_number": "505-727-6797",
            "fax_number": "505-727-9979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 MONTGOMERY BLVD NE STE 105",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091219",
            "telephone_number": "505-727-6797",
            "fax_number": "505-727-9979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFER",
        "first_name": "SUSAN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "RN, IBCLC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-21",
        "last_updated": "2017-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "NM",
            "license": "10912258",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NM",
            "license": "R43522",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shadow Mountain Health LLC.
• Shadow Mountain LLC.
• Shadow Mountain Recovery LLC.
• Darren M Shafer, DO
• Skylar Kane Shafer
• Diedre Ann Shaffer, LMHC
• Jaida Mariee Shaffer, PA-C
• Ryan Steven Shaffer, MD
• Cassandra Shafike, MD
• Aneeqa Shah, SPEECH THERAPIST

• All providers in Albuquerque, NM
• Lactation Consultant (Registered Nurse) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.