Provider Demographics
NPI:1679761852
Name:TREASURE COAST MATERNAL FETAL MEDICINE, PA
Entity Type:Organization
Organization Name:TREASURE COAST MATERNAL FETAL MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LENCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-288-9929
Mailing Address - Street 1:1545 SE PALM CT
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4914
Mailing Address - Country:US
Mailing Address - Phone:772-288-9929
Mailing Address - Fax:772-288-9931
Practice Address - Street 1:1545 SE PALM CT
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4914
Practice Address - Country:US
Practice Address - Phone:772-288-9929
Practice Address - Fax:772-288-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86568207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7352Medicare PIN