MEDICARE: ELLEN SHAPIRO LLC

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	103TC0700X	Clinical Psychologist	PY 3674	FL

General Provider Information

NPI Number	:	1497144661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN SHAPIRO LLC

Provider Business Mailing Address
First Line	:	1003 N ADAMS ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6132
Country	:	US
Telephone Number	:	850-222-0003
Fax Number	:	850-222-1311

Provider Business Practice Location Address
First Line	:	1003 N ADAMS ST
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32303-6132
Country	:	US
Telephone Number	:	850-222-0003
Fax Number	:	850-222-1311

Authorized Official
Title or Position	:	MEMBER/PSYCHOLOGIST
Name	:	DR. ELLEN SHAPIRO
Credential	:	PH.D
Telephone Number	:	850-556-2625

Provider Enumeration Date	:	01/12/2015
Last Update Date	:	01/14/2015

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