Healthcare Provider Details

I. General information

NPI: 1023192580
Provider Name (Legal Business Name): LEAH SHINBACH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BOTULPH LN
SANTA FE NM
87505-6912
US

IV. Provider business mailing address

401 BOTULPH LN
SANTA FE NM
87505-6912
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8387
  • Fax: 505-820-2733
Mailing address:
  • Phone: 505-983-8387
  • Fax: 505-820-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2000PA11
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: