Healthcare Provider Details

I. General information

NPI: 1083077135
Provider Name (Legal Business Name): DANIEL SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/30/2024
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02215
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone: 617-355-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number278335
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: