Holly Candice Shaffer

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

2008-01381 Issued in NC

Practice address

6781 Parker Farm Dr
Suite 300
Wilmington, NC 28405-3161

Phone

(910) 763-1555

NPI assigned

Aug 21, 2007

Last updated

Jun 7, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1952594178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6781 PARKER FARM DR",
            "address_2": "SUITE 300",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053161",
            "telephone_number": "910-763-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6781 PARKER FARM DR",
            "address_2": "SUITE 300",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053161",
            "telephone_number": "910-763-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "HOLLY",
        "middle_name": "CANDICE",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-21",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "2008-01381",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912439",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Marie Shackelford, PA-C
• Jarrel Lynne Shackleford, PA-C
• Holly Shadoin, OTR/L
• Susan Passafiume Shafer, LCMHC, LCAS
• Brianna Shaffer
• Joseph Crockett Shaffer II
• Michelle Leslie Shaffer, CCC-SLP
• Charlotte Shah, LCMHC, LCAS, CSI
• Fred Thomas Paul Shah, LCMHC, LCASA
• Jehan Rahim Shah, MD

• Dermatology Physician in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2013; 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.