Provider Demographics
NPI:1073863163
Name:SHAPIRO, KIMBERLY MILLIGAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MILLIGAN
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUNDROP WATCH
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2421
Mailing Address - Country:US
Mailing Address - Phone:561-271-8624
Mailing Address - Fax:
Practice Address - Street 1:461 S NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6138
Practice Address - Country:US
Practice Address - Phone:386-671-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106846363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical