Provider Demographics
NPI:1851267009
Name:SHAFACK, PETER
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:SHAFACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 ROCKY RIVER DR APT 8
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1151
Mailing Address - Country:US
Mailing Address - Phone:216-463-0848
Mailing Address - Fax:
Practice Address - Street 1:4041 ROCKY RIVER DR APT 8
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1151
Practice Address - Country:US
Practice Address - Phone:216-463-0848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker