MEDICARE: DR. SHALEASE SAWYER DO

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	207Q00000X	Family Medicine Physician	036.156885	IL
2	207Q00000X	Family Medicine Physician	DR.0064091	CO

General Provider Information

NPI Number	:	1558890590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHALEASE SAWYER DO

Provider Business Mailing Address
First Line	:	307 BOATNER RD
Second Line	:
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1302
Country	:	US
Telephone Number	:	850-883-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 BOATNER RD
Second Line	:
City	:	EGLIN AFB
State	:	FL
Zip	:	32542-1302
Country	:	US
Telephone Number	:	850-883-8600
Fax Number	:

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

Provider Enumeration Date	:	06/04/2017
Last Update Date	:	06/08/2026

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Directions to “ DR. SHALEASE SAWYER DO” Practice Location

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