Provider Demographics
NPI:1366207292
Name:SHLAFERMAN, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:SHLAFERMAN
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 1:151 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-3403
Mailing Address - Country:US
Mailing Address - Phone:413-313-4414
Mailing Address - Fax:
Practice Address - Street 1:4915 25TH AVE NE STE 205
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5668
Practice Address - Country:US
Practice Address - Phone:206-524-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program