Healthcare Provider Details

I. General information

NPI: 1275160814
Provider Name (Legal Business Name): JACOB IAN SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2169 SE OCEAN BLVD
STUART FL
34996-3305
US

IV. Provider business mailing address

3810 S KANNER HWY APT 1432
STUART FL
34994-4936
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number170843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: