Healthcare Provider Details

I. General information

NPI: 1750509824
Provider Name (Legal Business Name): ALISA DAVIDOW SHAPIRO C.P.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 CUMBERLAND ROAD
NEW KENT VA
23124
US

IV. Provider business mailing address

9407 CUMBERLAND ROAD
NEW KENT VA
23124
US

V. Phone/Fax

Practice location:
  • Phone: 804-966-2242
  • Fax:
Mailing address:
  • Phone: 804-966-2242
  • Fax: 804-966-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN1009520
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1009520
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0017142106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: