Leadem, Shirley N

Leadem, Shirley N is an individual health care provider with primary practice located at 1740 Tree Boulevard Suite 112, St Augustine FL 32084-5774. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Leadem, Shirley N can be contacted via phone (904) 829-6591.

Contact Information

Primary practice address
1740 Tree Boulevard Suite 112 St Augustine FL 32084-5774
Phone: (904) 829-6591
Fax: (904) 824-8856
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X ME88076 Florida

Profile Details

NPI number 1023194859
LBN Legal business name Leadem, Shirley N
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 27th, 2006
Last updated May 20th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023194859 NPPES
Florida Other 4049277 AETNA
Florida Other 377712 AETNA
Florida MEDICAID 267624900 AETNA

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