Provider Demographics
NPI:1457323776
Name:SHAPIRO, STACEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
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 1:40 CROSSWAYS PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2036
Mailing Address - Country:US
Mailing Address - Phone:516-677-9658
Mailing Address - Fax:516-677-9623
Practice Address - Street 1:40 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-677-9658
Practice Address - Fax:516-677-9623
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2021752080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine