=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295737849
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON J FOX-LEVINE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2005
-----------------------------------------------------
Last Update Date | 09/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13475 SOUTHERN BLVD STE 202
-----------------------------------------------------
City | LOXAHATCHEE GROVES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33470-9233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-798-2468
-----------------------------------------------------
Fax | 561-798-2733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 PALM BEACH LAKES BLVD STE 901
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-6506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-509-5009
-----------------------------------------------------
Fax | 561-738-1822
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME82722
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------