Provider Demographics
NPI:1366420721
Name:SHANAFELT, MICHAEL J (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:SHANAFELT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-0271
Mailing Address - Country:US
Mailing Address - Phone:330-923-7066
Mailing Address - Fax:330-923-8090
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:STE B
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2400
Practice Address - Country:US
Practice Address - Phone:330-678-7782
Practice Address - Fax:330-678-7892
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2036371Medicaid
0821463Medicare PIN
0821462Medicare PIN
G48768Medicare UPIN
110164249Medicare PIN