Healthcare Provider Details

I. General information

NPI: 1568626125
Provider Name (Legal Business Name): ANNA SHAPIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EAST GENESEE ST. SUITE 101
SYRACUSE NY
13210
US

IV. Provider business mailing address

60 PRESIDENTIAL PLZ MADISON TOWERS #208
SYRACUSE NY
13202-2292
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-3535
  • Fax: 315-476-4140
Mailing address:
  • Phone: 315-464-2020
  • Fax: 315-464-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number252570-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: