Provider Demographics
NPI:1710575832
Name:SHAPIRO, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12989 SOUTHERN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9291
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:844-959-0418
Practice Address - Street 1:12989 SOUTHERN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9291
Practice Address - Country:US
Practice Address - Phone:561-627-8500
Practice Address - Fax:844-959-0418
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9116482363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical