Individual
DR. SHIRLEY N LEADEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1740 TREE BOULEVARD, SUITE 112, ST AUGUSTINE, FL 32084-5774
(904) 829-6591
(904) 824-8856
Mailing address
1740 TREE BOULEVARD, SUITE 112, ST AUGUSTINE, FL 32084-5774
(904) 829-6591
(904) 824-8856
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME88076
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267624900
—
FL
01
—
377712
BC/BS
FL
01
—
4049277
AETNA
FL
Enumeration date
10/27/2006
Last updated
05/20/2015
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