Provider Demographics
NPI:1437394111
Name:SHAPIRO, JESSICA ROSE (MAC, LAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROYLENCROFT LN
Mailing Address - Street 2:
Mailing Address - City:ROSE VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19063-4237
Mailing Address - Country:US
Mailing Address - Phone:610-357-2261
Mailing Address - Fax:
Practice Address - Street 1:1190 W NORTHERN PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1431
Practice Address - Country:US
Practice Address - Phone:610-357-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist