MEDICARE: JEFFREY GUNNER SHAPIRO PH.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	103G00000X	Clinical Neuropsychologist	PS 200349	PA
2	103TC0700X	Clinical Psychologist	PS 002349L	PA

General Provider Information

NPI Number	:	1609861277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY GUNNER SHAPIRO PH.D.

Provider Business Mailing Address
First Line	:	143 UPLAND TER
Second Line	:
City	:	BALA
State	:	PA
Zip	:	19004-3126
Country	:	US
Telephone Number	:	610-667-0836
Fax Number	:	610-667-8655

Provider Business Practice Location Address
First Line	:	14 E STRATFORD AVE
Second Line	:
City	:	LANSDOWNE
State	:	PA
Zip	:	19050-2042
Country	:	US
Telephone Number	:	610-667-0836
Fax Number	:	610-667-8655

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	09/11/2025

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