Provider Demographics
NPI:1669724886
Name:SHAPIRO, MICHAEL RANDALL (LMT, CLT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RANDALL
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:LMT, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MELANIE LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-5831
Mailing Address - Country:US
Mailing Address - Phone:646-236-2932
Mailing Address - Fax:
Practice Address - Street 1:25 MELANIE LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-5831
Practice Address - Country:US
Practice Address - Phone:646-236-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023916172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist