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General NPI Number Information
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NPI Number | 1295024636
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Entity Type | Organization
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Legal Business Name | LESLIE SHAWN D.O. P.A.
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 400 N HIATUS RD SUITE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5214
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Country | US
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Telephone | 954-442-3434
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Fax | 954-441-4425
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Provider Business Mailing Address
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Address Line | 400 N HIATUS RD SUITE 201
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-5214
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Country | US
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Telephone | 954-442-3434
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Fax | 954-441-4425
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LESLIE GORDON SHAWN
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Credential | D.O.
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Telephone | 954-442-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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