Provider Demographics
NPI:1801169248
Name:SHUR, LESLIE TADZYNSKI (DO)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:TADZYNSKI
Last Name:SHUR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 TELNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-4214
Mailing Address - Country:US
Mailing Address - Phone:215-248-4477
Mailing Address - Fax:215-248-2110
Practice Address - Street 1:540 TELNER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-4214
Practice Address - Country:US
Practice Address - Phone:215-248-4477
Practice Address - Fax:215-248-2110
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004602L208000000X
NJ25MB04452600208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics