Provider Demographics
NPI:1568542660
Name:SHAPIRO, PHYLISS HIPSHMAN (MD)
Entity Type:Individual
Prefix:
First Name:PHYLISS
Middle Name:HIPSHMAN
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 1:2590 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615
Mailing Address - Country:US
Mailing Address - Phone:203-375-3665
Mailing Address - Fax:203-378-1340
Practice Address - Street 1:2590 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-375-3665
Practice Address - Fax:203-378-1340
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001279736Medicaid
CT001279736Medicaid
D02385Medicare UPIN