Healthcare Provider Details

I. General information

NPI: 1962483206
Provider Name (Legal Business Name): MICHAEL STEVEN SHAPIRO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 01/17/2020
Certification Date: 01/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-0100
  • Fax: 910-678-7022
Mailing address:
  • Phone: 910-678-0100
  • Fax: 910-678-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5209
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number5209
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: