Provider Demographics
NPI:1194795807
Name:SHEN, THOMAS J (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:SHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0073924207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5923541OtherAETNA
FL252644100Medicaid
FL41838OtherBLUE CROSS AND BLUESHIELD
FLG23772Medicare UPIN
FL252644100Medicaid