Healthcare Provider Details

I. General information

NPI: 1104870393
Provider Name (Legal Business Name): BREVARD EMERGENCY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W EAU GALLIE BLVD SUITE A
MELBOURNE FL
32935-3185
US

IV. Provider business mailing address

2080 W EAU GALLIE BLVD SUITE A
MELBOURNE FL
32935-3185
US

V. Phone/Fax

Practice location:
  • Phone: 321-254-6218
  • Fax: 321-254-6230
Mailing address:
  • Phone: 321-254-6218
  • Fax: 321-254-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALAN SHAPIRO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 321-254-6218