Provider Demographics
NPI:1376590935
Name:SHANFELD, LEAH ELISE (OD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ELISE
Last Name:SHANFELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3545
Mailing Address - Country:US
Mailing Address - Phone:610-202-7214
Mailing Address - Fax:
Practice Address - Street 1:227 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2219
Practice Address - Country:US
Practice Address - Phone:516-599-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-006280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU83985Medicare UPIN