MEDICARE: DR. LEYUN SHAO A.P.

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	171100000X	Acupuncturist	611	FL

General Provider Information

NPI Number	:	1396965414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEYUN SHAO A.P.

Provider Business Mailing Address
First Line	:	2815 W VIRGINIA AVE
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-6357
Country	:	US
Telephone Number	:	813-872-4868
Fax Number	:	813-872-4868

Provider Business Practice Location Address
First Line	:	2815 W VIRGINIA AVE
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607-6357
Country	:	US
Telephone Number	:	813-872-4868
Fax Number	:	813-872-4868

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	07/08/2007

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