Provider Demographics
NPI:1003356486
Name:STACY SHAPIRO, SLP-CCC, P.C.
Entity type:Organization
Organization Name:STACY SHAPIRO, SLP-CCC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:631-553-1536
Mailing Address - Street 1:103 DEER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1567
Mailing Address - Country:US
Mailing Address - Phone:631-553-1536
Mailing Address - Fax:
Practice Address - Street 1:103 DEER VALLEY DR
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1567
Practice Address - Country:US
Practice Address - Phone:631-553-1536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010923-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency