MEDICARE: MS. SIDRA SHAPIRO MS, CGC

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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1447249321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SIDRA SHAPIRO MS, CGC

Provider Business Mailing Address
First Line	:	2011 PINTO LN
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4018
Country	:	US
Telephone Number	:	702-382-3200
Fax Number	:	702-382-3575

Provider Business Practice Location Address
First Line	:	2011 PINTO LN
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4018
Country	:	US
Telephone Number	:	702-382-3200
Fax Number	:	702-382-3575

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	08/12/2008

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