Provider Demographics
NPI:1215039896
Name:SHAPIRO, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9926 BUNKER RD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3601
Mailing Address - Country:US
Mailing Address - Phone:352-365-0229
Mailing Address - Fax:352-365-6323
Practice Address - Street 1:9926 BUNKER RD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3601
Practice Address - Country:US
Practice Address - Phone:352-365-0229
Practice Address - Fax:352-365-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42041207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64499OtherBLUE CROSS BLUE SHIELD
FL067754000Medicaid
FLC89575Medicare UPIN
FL64499AMedicare ID - Type Unspecified