Provider Demographics
NPI:1053093864
Name:A NEAL, CRISTAFER
Entity type:Individual
Prefix:
First Name:CRISTAFER
Middle Name:
Last Name:A NEAL
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 1:4379 SILVERDALE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2620
Mailing Address - Country:US
Mailing Address - Phone:216-319-9671
Mailing Address - Fax:
Practice Address - Street 1:4379 SILVERDALE RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2620
Practice Address - Country:US
Practice Address - Phone:216-319-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR977166172A00000X, 174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174200000XOther Service ProvidersMeals
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty