Healthcare Provider Details

I. General information

NPI: 1205814258
Provider Name (Legal Business Name): SCOTT B SHAPIRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 OLD MONROE RD STE G
INDIAN TRAIL NC
28079-5360
US

IV. Provider business mailing address

6640 OLD MONROE RD STE G
INDIAN TRAIL NC
28079-5360
US

V. Phone/Fax

Practice location:
  • Phone: 704-282-9355
  • Fax: 888-859-9355
Mailing address:
  • Phone: 704-282-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9601722
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberR2532
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: