Provider Demographics
NPI:1780675074
Name:SHAFF, LESLIE PAULETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:PAULETTE
Last Name:SHAFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MALL RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:781-744-7299
Mailing Address - Fax:781-744-2788
Practice Address - Street 1:41 MALL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01805-0001
Practice Address - Country:US
Practice Address - Phone:781-744-7299
Practice Address - Fax:781-744-2788
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55013207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110047231AMedicaid
MA055013OtherTUFTS HEALTH PLAN
MAJ07933OtherBCBS MA
MA110047231AMedicaid
MAJ07933OtherBCBS MA