MEDICARE: DAVID A SHAPIRO, PH.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist
2	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1942641568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID A SHAPIRO, PH.D., P.C.

Provider Business Mailing Address
First Line	:	1301 S 8TH ST
Second Line	:	SUITE 301
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	719-634-6887
Fax Number	:	719-630-7858

Provider Business Practice Location Address
First Line	:	1301 S 8TH ST
Second Line	:	SUITE 301
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80905-7335
Country	:	US
Telephone Number	:	719-634-6887
Fax Number	:	719-630-7858

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. DAVID ADAM SHAPIRO
Credential	:	PH.D.
Telephone Number	:	719-634-6887

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	07/11/2013

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