MEDICARE: LEON SHAFFOLD

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	343900000X	Non-emergency Medical Transport (VAN)	188735	OH

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	:	1982011243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEON SHAFFOLD

Provider Business Mailing Address
First Line	:	12600 ROCKSIDE RD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-4525
Country	:	US
Telephone Number	:	216-510-4984
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 ROCKSIDE RD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-4525
Country	:	US
Telephone Number	:	216-510-4984
Fax Number	:

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

Provider Enumeration Date	:	07/18/2014
Last Update Date	:	07/18/2014

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Directions to “ LEON SHAFFOLD ” Practice Location

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