MEDICARE: SHAIAN MARTIN

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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1063185205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAIAN MARTIN

Provider Business Mailing Address
First Line	:	27 CHELSEA LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7738
Country	:	US
Telephone Number	:	954-398-2829
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 CHELSEA LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-7738
Country	:	US
Telephone Number	:	954-398-2829
Fax Number	:

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

Provider Enumeration Date	:	07/25/2021
Last Update Date	:	07/25/2021

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Directions to “ SHAIAN MARTIN ” Practice Location

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