Provider Demographics
NPI:1750509824
Name:SHAPIRO, ALISA DAVIDOW (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:DAVIDOW
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 CUMBERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124
Mailing Address - Country:US
Mailing Address - Phone:804-966-2242
Mailing Address - Fax:804-966-5639
Practice Address - Street 1:9407 CUMBERLAND ROAD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124
Practice Address - Country:US
Practice Address - Phone:804-966-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009520163WP0200X, 363LP0200X
VA0017142106363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics