MEDICARE: DR. MARY E SHAPIRO MD

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	208000000X	Pediatrics Physician	61039931205	UT

General Provider Information

NPI Number	:	1174578611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY E SHAPIRO MD

Provider Business Mailing Address
First Line	:	PO BOX 510708
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84151-0708
Country	:	US
Telephone Number	:	801-213-3900
Fax Number	:	801-585-3655

Provider Business Practice Location Address
First Line	:	3730 W 4700 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84118-3457
Country	:	US
Telephone Number	:	801-213-9200
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	10/19/2021

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