Healthcare Provider Details

I. General information

NPI: 1609861277
Provider Name (Legal Business Name): JEFFREY GUNNER SHAPIRO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 E STRATFORD AVE
LANSDOWNE PA
19050-2042
US

IV. Provider business mailing address

143 UPLAND TER
BALA PA
19004-3126
US

V. Phone/Fax

Practice location:
  • Phone: 610-667-0836
  • Fax: 610-667-8655
Mailing address:
  • Phone: 610-667-0836
  • Fax: 610-667-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS 200349
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS 002349L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: