MEDICARE: SHORE PROSTHETICS AND ORTHOTICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1043085210
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE PROSTHETICS AND ORTHOTICS LLC

Provider Business Mailing Address
First Line	:	14055 CEDAR RD STE 107
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44118-3333
Country	:	US
Telephone Number	:	410-897-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 ESTATE LA GRANDE PRINCESSE STE 7
Second Line	:
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820-4328
Country	:	US
Telephone Number	:	340-714-1009
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	IVAN SABEL
Credential	:
Telephone Number	:	410-897-1141

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	05/12/2026

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