Provider Demographics
NPI:1295791465
Name:SFAKIANOS, PETER NICHOLAS (MD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:NICHOLAS
Last Name:SFAKIANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 MILTON RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-5100
Mailing Address - Country:US
Mailing Address - Phone:530-676-3161
Mailing Address - Fax:
Practice Address - Street 1:1580 CREEKSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3886
Practice Address - Country:US
Practice Address - Phone:916-984-4500
Practice Address - Fax:916-984-4502
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB57949Medicare UPIN