Healthcare Provider Details

I. General information

NPI: 1356824114
Provider Name (Legal Business Name): JULIETTA RACHEL SHAPIRO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 N TATUM BLVD STE 190
PHOENIX AZ
85050-4251
US

IV. Provider business mailing address

20950 N TATUM BLVD STE 190
PHOENIX AZ
85050-4251
US

V. Phone/Fax

Practice location:
  • Phone: 602-776-0021
  • Fax: 623-742-2061
Mailing address:
  • Phone: 480-776-0021
  • Fax: 623-742-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60912915
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7171
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: