Healthcare Provider Details

I. General information

NPI: 1992633622
Provider Name (Legal Business Name): CAROL A SHAPIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 N LA CHOLLA BLVD
TUCSON AZ
85705-2009
US

IV. Provider business mailing address

4545 N LA CHOLLA BLVD
TUCSON AZ
85705-2009
US

V. Phone/Fax

Practice location:
  • Phone: 520-696-8840
  • Fax:
Mailing address:
  • Phone: 520-696-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number10242655
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: