Provider Demographics
NPI:1831124858
Name:SHAPIRO, TIFFANY B (DO)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:B
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HARADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 FOULK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3155
Practice Address - Country:US
Practice Address - Phone:302-655-8868
Practice Address - Fax:302-655-3744
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012584207Q00000X
DEC2-0011393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2116020OtherMAMSI-YH
PA50018554OtherCAPITAL BLUE CROSS-YH
MD620767OtherCAREFIRST MD BCBS
PA001950140Medicaid
PA1500059OtherHIGHMARK BLUE SHIELD
PA100483OtherGEISINGER
PA5917601OtherAETNA
PAP005986OtherGATEWAY-YH
PA105522OtherJOHNS HOPKINS
PA143541OtherUNISON-YH
PA20024912OtherAMERIHEALTH MERCY-YH
PA001950140Medicaid
PA069006EZ3Medicare PIN
PA20024912OtherAMERIHEALTH MERCY-YH