Healthcare Provider Details

I. General information

NPI: 1023289907
Provider Name (Legal Business Name): ILENE M SHAPIRO MA,CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SOUTH BROADWAY ENT AND ALLERGY ASSOC
WHITE PLAINS NY
10601
US

IV. Provider business mailing address

75 SOUTH BROADWAY ENT AND ALLERGY ASSOC
WHITE PLAINS NY
10601
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-3888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: