=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093395477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEEORA SHIFTEH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2021
-----------------------------------------------------
Last Update Date | 10/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 ALTON RD
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-674-2387
-----------------------------------------------------
Fax | 954-964-6084
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 628 N ISLAND
-----------------------------------------------------
City | GOLDEN BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-2257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-729-4084
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 148802
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 11017458
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 688367
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------