Healthcare Provider Details

I. General information

NPI: 1679761852
Provider Name (Legal Business Name): TREASURE COAST MATERNAL FETAL MEDICINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SE PALM CT
STUART FL
34994-4914
US

IV. Provider business mailing address

1545 SE PALM CT
STUART FL
34994-4914
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-9929
  • Fax: 772-288-9931
Mailing address:
  • Phone: 772-288-9929
  • Fax: 772-288-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberME86568
License Number StateFL

VIII. Authorized Official

Name: DR. SHAUN LENCKI
Title or Position: PRESIDENT
Credential:
Phone: 772-288-9929