MEDICARE: DR. SUSAN SHAPIRO PHD MS MS RDN FAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY14277	CA
2	103T00000X	Psychologist	PSY 14277	CA

General Provider Information

NPI Number	:	1023214624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN SHAPIRO PHD MS MS RDN FAND

Provider Business Mailing Address
First Line	:	1647 S HAYWORTH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4513
Country	:	US
Telephone Number	:	310-659-7800
Fax Number	:	833-392-1146

Provider Business Practice Location Address
First Line	:	1647 S HAYWORTH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4513
Country	:	US
Telephone Number	:	310-659-7800
Fax Number	:	833-392-1146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	08/04/2021

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