Healthcare Provider Details

I. General information

NPI: 1104810977
Provider Name (Legal Business Name): CINDY A SHIRO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 HAMILTON ST FL 2
SOUTHBRIDGE MA
01550-1859
US

IV. Provider business mailing address

428 HAMILTON ST FL 2
SOUTHBRIDGE MA
01550-1859
US

V. Phone/Fax

Practice location:
  • Phone: 774-402-8560
  • Fax: 774-402-8563
Mailing address:
  • Phone: 774-402-8560
  • Fax: 774-402-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number156644
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: