=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841636131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELANA SHPALL MD, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2013
-----------------------------------------------------
Last Update Date | 08/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 30TH ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94131-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-550-2230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 CEDAR ST P.O. BOX 208030
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06510-3206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-688-2984
-----------------------------------------------------
Fax | 203-688-4092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 141597
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------