Provider Demographics
NPI:1609056308
Name:SHAPIRO, GEORGIA DANIELA (MD)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:DANIELA
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:DANIELA
Other - Last Name:GONSALVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1460 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4849
Mailing Address - Country:US
Mailing Address - Phone:772-562-7777
Mailing Address - Fax:772-778-8117
Practice Address - Street 1:1460 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4849
Practice Address - Country:US
Practice Address - Phone:772-562-7777
Practice Address - Fax:772-778-8117
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME113568207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARES0000Medicare UPIN