Provider Demographics
NPI:1598904948
Name:LEGACY MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:LEGACY MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-775-6455
Mailing Address - Street 1:649 US HIGHWAY 1 STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-4616
Mailing Address - Country:US
Mailing Address - Phone:561-775-6455
Mailing Address - Fax:561-775-6456
Practice Address - Street 1:649 US HIGHWAY 1 STE 2
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-4616
Practice Address - Country:US
Practice Address - Phone:561-775-6455
Practice Address - Fax:561-775-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46320SMedicare PIN
FL78605WMedicare PIN
FLG26049Medicare UPIN