Healthcare Provider Details

I. General information

NPI: 1699142851
Provider Name (Legal Business Name): DANIEL I SHAPIRO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 STOCKTON BLVD
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2230 STOCKTON BLVD
SACRAMENTO CA
95817-1353
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7875
  • Fax: 916-734-7539
Mailing address:
  • Phone: 916-734-7875
  • Fax: 916-734-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003876
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10161
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: