MEDICARE: DR. GABRIELLE LESLIE 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	2084P0804X	Child & Adolescent Psychiatry Physician	103107	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A050725	OTHER	CA	LICENSE
2	103107	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1669509055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELLE LESLIE SHAPIRO M.D.

Provider Business Mailing Address
First Line	:	343 E 74TH ST
Second Line	:	APTPH4C
City	:	NEW YORK
State	:	NY
Zip	:	10021-3752
Country	:	US
Telephone Number	:	212-628-0729
Fax Number	:	212-628-0753

Provider Business Practice Location Address
First Line	:	343 E 74TH ST
Second Line	:	APTPH4C
City	:	NEW YORK
State	:	NY
Zip	:	10021-3752
Country	:	US
Telephone Number	:	212-628-0729
Fax Number	:	212-628-0753

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	03/07/2023

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