Provider Demographics
NPI:1609861277
Name:SHAPIRO, JEFFREY GUNNER (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:GUNNER
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 UPLAND TER
Mailing Address - Street 2:
Mailing Address - City:BALA
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3126
Mailing Address - Country:US
Mailing Address - Phone:610-667-0836
Mailing Address - Fax:610-667-8655
Practice Address - Street 1:14 E STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2042
Practice Address - Country:US
Practice Address - Phone:610-667-0836
Practice Address - Fax:610-667-8655
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 200349103G00000X
PAPS 002349L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical