Provider Demographics
NPI:1033283080
Name:SHAPIRO, MARCEY ELLEN (MD)
Entity Type:Individual
Prefix:MS
First Name:MARCEY
Middle Name:ELLEN
Last Name:SHAPIRO
Suffix:
Gender:F
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:EMBUDO
Mailing Address - State:NM
Mailing Address - Zip Code:87531-0247
Mailing Address - Country:US
Mailing Address - Phone:510-525-2200
Mailing Address - Fax:510-526-9648
Practice Address - Street 1:16 PRIVATE DRIVE 1103
Practice Address - Street 2:
Practice Address - City:EMBUDO
Practice Address - State:NM
Practice Address - Zip Code:87531
Practice Address - Country:US
Practice Address - Phone:510-525-2200
Practice Address - Fax:510-526-9648
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG083515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F37734Medicare UPIN