MEDICARE: DR. LEAH SHELL DO

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	207Q00000X	Family Medicine Physician	OS18103	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225525223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEAH SHELL DO

Provider Business Mailing Address
First Line	:	PO BOX 776084
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6084
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 GARTH BROOKS BLVD STE 215
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-3890
Country	:	US
Telephone Number	:	405-494-3370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	03/10/2026

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Directions to “ DR. LEAH SHELL DO” Practice Location

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