Provider Demographics
NPI:1851470454
Name:SHAPIRO, KATHY ANN (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2204
Mailing Address - Country:US
Mailing Address - Phone:650-756-4663
Mailing Address - Fax:650-756-2021
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2204
Practice Address - Country:US
Practice Address - Phone:650-756-4663
Practice Address - Fax:650-756-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG063009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ 218 41ZOtherPTAN
CAGR0041950Medicaid
CAZZZ 218 41ZOtherPTAN