Provider Demographics
NPI:1801138953
Name:SHAPIRO, MILDA (DO)
Entity type:Individual
Prefix:DR
First Name:MILDA
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MILDA
Other - Middle Name:
Other - Last Name:PALIONYTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:98 N 1100 E STE 202
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003
Practice Address - Country:US
Practice Address - Phone:801-492-2537
Practice Address - Fax:801-492-2537
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10809883-1204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery