Provider Demographics
NPI:1669445623
Name:LEU, SHANNON T (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:T
Last Name:LEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 43667
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-3667
Mailing Address - Country:US
Mailing Address - Phone:904-720-0599
Mailing Address - Fax:904-376-4036
Practice Address - Street 1:559 W TWINCOURT TRL UNIT 601
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8805
Practice Address - Country:US
Practice Address - Phone:904-493-8383
Practice Address - Fax:904-376-3209
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME94806207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20260Medicare UPIN
FLP00284498Medicare PIN
FL32924ZMedicare PIN