Healthcare Provider Details

I. General information

NPI: 1932172996
Provider Name (Legal Business Name): SHIREE SAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 SMITH ST
ORANGE PARK FL
32073-5554
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-269-2140
  • Fax: 904-264-3018
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME70896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: