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General NPI Number Information
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NPI Number | 1700933405
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Entity Type | Organization
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Legal Business Name | SHOSHANA E. ENGLARD MD PA
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1835 COUNTY ROAD C W
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City | ROSEVILLE
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State | MN
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Zip | 55113-1352
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Country | US
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Telephone | 651-770-2807
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Fax |
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Provider Business Mailing Address
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Address Line | 614 PORTLAND AVE SUITE #108
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City | SAINT PAUL
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State | MN
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Zip | 55102-2223
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Country | US
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Telephone | 651-770-2807
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. SHOSHANA ESTHER ENGLARD-FALCONER
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Credential | M.D.
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Telephone | 651-770-2807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 28856
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License Number State | MN
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