Provider Demographics
NPI:1154633998
Name:SHAPER, DANIELLE LEVIN (DPM)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEVIN
Last Name:SHAPER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24604 LETCHWORTH RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4145
Mailing Address - Country:US
Mailing Address - Phone:216-382-8070
Mailing Address - Fax:
Practice Address - Street 1:5035 MAYFIELD RD STE 215
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2603
Practice Address - Country:US
Practice Address - Phone:216-382-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1256213ES0103X
OH3773213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery