Provider Demographics
NPI:1659868370
Name:LEON, SHAKIRA ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAKIRA
Middle Name:ALICIA
Last Name:LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHAKIRA
Other - Middle Name:ALICIA
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 EXECUTIVE PARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1838
Mailing Address - Country:US
Mailing Address - Phone:704-237-4240
Mailing Address - Fax:252-744-4237
Practice Address - Street 1:12985 SW 130TH CT UNIT 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5346
Practice Address - Country:US
Practice Address - Phone:786-783-6583
Practice Address - Fax:704-785-8304
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
NC2401762084P0800X
FLME1596932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program