MEDICARE: BRUCE SHAPIRO M.D.

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	2084P0800X	Psychiatry Physician	26833	CT

General Provider Information

NPI Number	:	1548271240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE SHAPIRO M.D.

Provider Business Mailing Address
First Line	:	666 GLENBROOK RD
Second Line	:	RIVER SUITE
City	:	STAMFORD
State	:	CT
Zip	:	06906-1439
Country	:	US
Telephone Number	:	203-327-4144
Fax Number	:	203-327-4143

Provider Business Practice Location Address
First Line	:	666 GLENBROOK RD
Second Line	:	RIVER SUITE
City	:	STAMFORD
State	:	CT
Zip	:	06906-1439
Country	:	US
Telephone Number	:	203-327-4144
Fax Number	:	203-327-4143

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/09/2007

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