Healthcare Provider Details

I. General information

NPI: 1215039896
Provider Name (Legal Business Name): SCOTT SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9926 BUNKER RD
LEESBURG FL
34788-3601
US

IV. Provider business mailing address

9926 BUNKER RD
LEESBURG FL
34788-3601
US

V. Phone/Fax

Practice location:
  • Phone: 352-874-8647
  • Fax: 352-365-6323
Mailing address:
  • Phone: 352-874-8647
  • Fax: 352-365-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME42041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: