Healthcare Provider Details

I. General information

NPI: 1871846980
Provider Name (Legal Business Name): RICHARD J SHAPIRO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3141 HAMBLIN WAY
WELLINGTON FL
33414-3427
US

IV. Provider business mailing address

3141 HAMBLIN WAY
WELLINGTON FL
33414-3427
US

V. Phone/Fax

Practice location:
  • Phone: 561-370-3635
  • Fax: 561-899-3990
Mailing address:
  • Phone: 561-370-3635
  • Fax: 561-899-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: