Provider Demographics
NPI:1063910347
Name:SHAPIRO, JENNA S
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:S
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 2ND AVE APT 3S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8241
Mailing Address - Country:US
Mailing Address - Phone:561-306-7535
Mailing Address - Fax:
Practice Address - Street 1:509 W 129TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-2532
Practice Address - Country:US
Practice Address - Phone:212-505-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist