Healthcare Provider Details

I. General information

NPI: 1003043753
Provider Name (Legal Business Name): AMY MELISSA SHAPIRO RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

3300 DOUGLAS BLVD SUITE 405
ROSEVILLE CA
95661-3844
US

V. Phone/Fax

Practice location:
  • Phone: 916-962-8700
  • Fax:
Mailing address:
  • Phone: 916-782-5705
  • Fax: 916-782-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number641003
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: