Provider Demographics
NPI:1023214624
Name:SHAPIRO, SUSAN (PHD MS MS RDN FAND)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PHD MS MS RDN FAND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 S HAYWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-4513
Mailing Address - Country:US
Mailing Address - Phone:310-659-7800
Mailing Address - Fax:833-392-1146
Practice Address - Street 1:1647 S HAYWORTH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4513
Practice Address - Country:US
Practice Address - Phone:310-659-7800
Practice Address - Fax:833-392-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14277103T00000X
CAPSY 14277103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist