Provider Demographics
NPI:1487728507
Name:SHAPIRO, STEPHEN ROY (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ROY
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 SCRIPPS DR
Mailing Address - Street 2:SUITE # 114
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6372
Mailing Address - Country:US
Mailing Address - Phone:916-649-8991
Mailing Address - Fax:916-649-2915
Practice Address - Street 1:87 SCRIPPS DR
Practice Address - Street 2:SUITE # 114
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6372
Practice Address - Country:US
Practice Address - Phone:916-649-8991
Practice Address - Fax:916-649-2915
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG222052088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069580Medicaid
CAGR0069580Medicaid