Provider Demographics
NPI:1972525517
Name:SHAPIRO, ELAINE JANET (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:JANET
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:JANET
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1625 W INA RD
Mailing Address - Street 2:STE 117
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1975
Mailing Address - Country:US
Mailing Address - Phone:520-297-1366
Mailing Address - Fax:520-297-0129
Practice Address - Street 1:1625 W INA RD
Practice Address - Street 2:STE 117
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1975
Practice Address - Country:US
Practice Address - Phone:520-297-1366
Practice Address - Fax:520-297-0129
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT42134Medicare UPIN
AZ0766260001Medicare NSC