Provider Demographics
NPI:1609146075
Name:SHAPIRO, DIANA (MS, CCC-SLP, TSSLD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MS, CCC-SLP, TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 63RD ST, APT 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3143
Mailing Address - Country:US
Mailing Address - Phone:917-418-5985
Mailing Address - Fax:
Practice Address - Street 1:4812 9TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2418
Practice Address - Country:US
Practice Address - Phone:718-633-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022097235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist