MEDICARE: MS. JULIETTA RACHEL SHAPIRO PA-C

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	363A00000X	Physician Assistant	60912915	WA
2	363A00000X	Physician Assistant	7171	AZ
3	363A00000X	Physician Assistant		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356824114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIETTA RACHEL SHAPIRO PA-C

Provider Business Mailing Address
First Line	:	20950 N TATUM BLVD STE 190
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4251
Country	:	US
Telephone Number	:	480-776-0021
Fax Number	:	623-742-2061

Provider Business Practice Location Address
First Line	:	20950 N TATUM BLVD STE 190
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4251
Country	:	US
Telephone Number	:	602-776-0021
Fax Number	:	623-742-2061

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	02/15/2024

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