Healthcare Provider Details

I. General information

NPI: 1023943008
Provider Name (Legal Business Name): PETER M SHAFIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNIVERSITY PARK DR
NASHVILLE TN
37204-3956
US

IV. Provider business mailing address

5161 RICE RD APT 206
ANTIOCH TN
37013-2022
US

V. Phone/Fax

Practice location:
  • Phone: 615-710-8469
  • Fax:
Mailing address:
  • Phone: 615-710-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: