Provider Demographics
NPI:1386659746
Name:LEIKEN, SHULI (PA-C)
Entity Type:Individual
Prefix:
First Name:SHULI
Middle Name:
Last Name:LEIKEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21724
Mailing Address - Street 2:CARE OF UNITED SURGICAL ASSISTANTS NA, INC.
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1724
Mailing Address - Country:US
Mailing Address - Phone:877-872-5788
Mailing Address - Fax:
Practice Address - Street 1:12880 COMMODITY PL
Practice Address - Street 2:CARE OF UNITED SURGICAL ASSISTANTS NA, INC.
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3101
Practice Address - Country:US
Practice Address - Phone:877-872-5788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001942363AS0400X
NC0010-01267363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ17156Medicare UPIN
ILK07094Medicare ID - Type Unspecified