Provider Demographics
NPI:1295024636
Name:LESLIE SHAWN D.O. P.A.
Entity type:Organization
Organization Name:LESLIE SHAWN D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:SHAWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-442-3434
Mailing Address - Street 1:400 N HIATUS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5214
Mailing Address - Country:US
Mailing Address - Phone:954-442-3434
Mailing Address - Fax:954-441-4425
Practice Address - Street 1:400 N HIATUS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5214
Practice Address - Country:US
Practice Address - Phone:954-442-3434
Practice Address - Fax:954-441-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty