Healthcare Provider Details

I. General information

NPI: 1477591709
Provider Name (Legal Business Name): HENRY J SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 UNIVERSITY BLVD
JUPITER FL
33458-3103
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING AND RELATIONS DEPT.
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 561-748-2488
  • Fax: 561-748-2468
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME33108
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME33041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: