Healthcare Provider Details

I. General information

NPI: 1972544112
Provider Name (Legal Business Name): WILLIAM DAVID SHAPIRO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD MOSS 1
PHILADELPHIA PA
19141-3098
US

IV. Provider business mailing address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3098
US

V. Phone/Fax

Practice location:
  • Phone: 215-517-8665
  • Fax: 215-581-3934
Mailing address:
  • Phone: 215-517-8665
  • Fax: 215-581-3934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS004624-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: