Provider Demographics
NPI:1841258027
Name:ALLERGY ASTHMA & IMMUNOLOGY CENTER, INC
Entity type:Organization
Organization Name:ALLERGY ASTHMA & IMMUNOLOGY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-314-2929
Mailing Address - Street 1:8245 COUNTY ROAD 44 LEG A
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3751
Mailing Address - Country:US
Mailing Address - Phone:352-314-2929
Mailing Address - Fax:352-314-9747
Practice Address - Street 1:8245 COUNTY ROAD 44 LEG A
Practice Address - Street 2:SUITE 1
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3751
Practice Address - Country:US
Practice Address - Phone:352-314-2929
Practice Address - Fax:352-314-9747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0073924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4820Medicare ID - Type Unspecified
FLFS960AMedicare PIN