Provider Demographics
NPI:1760365571
Name:SHAFER, PATRICK SEAN ALOYSIUS
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:SEAN ALOYSIUS
Last Name:SHAFER
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 1:131 VAN BOLEN WAY
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3181
Mailing Address - Country:US
Mailing Address - Phone:201-774-5793
Mailing Address - Fax:
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5503
Practice Address - Country:US
Practice Address - Phone:201-774-5793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS