Basic Information
| Provider Information | |||||||||
| NPI: | 1093395477 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHIFTEH | ||||||||
| FirstName: | LEEORA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 GREYROCK PL APT 502 | ||||||||
| Address2: | |||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069013106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477294084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4300 ALTON RD | ||||||||
| Address2: | |||||||||
| City: | MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331402948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056742387 | ||||||||
| FaxNumber: | 9549646084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2021 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 688367 | NY | N | Nursing Service Providers | Registered Nurse | 163W00000X | 148802 | CT | N | Nursing Service Providers | Registered Nurse | 367500000X | 11017458 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.