Active NPI
Leslie A Shinobu, MD PHD
- Neurology Physician
- Boston, MA
National Provider Identifier
1699754507
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 78256
- Practice address
- 15 Parkman St
Wac 830 Neurology Associates
Boston, MA 02114-3117 - Phone
- (617) 726-5532
- Fax
- (617) 726-6991
- NPI assigned
- Jan 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 78256 | MA | Primary |
Addresses
Primary practice location
15 Parkman St
Wac 830 Neurology Associates
Boston, MA 02114-3117
Mailing address
PO Box 9142
Mass General Physician Organization
Charlestown, MA 02129-9142
Phone (617) 724-0287
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J16437 | Other | MA | BCBS MA |
| 078256 | Other | MA | TUFTS HEALTH PLAN |
| 3148289 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78256 | MA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699754507",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9142",
"address_2": "MASS GENERAL PHYSICIAN ORGANIZATION",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021299142",
"telephone_number": "617-724-0287",
"fax_number": "617-726-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 PARKMAN ST",
"address_2": "WAC 830 NEUROLOGY ASSOCIATES",
"city": "BOSTON",
"state": "MA",
"postal_code": "021143117",
"telephone_number": "617-726-5532",
"fax_number": "617-726-6991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHINOBU",
"first_name": "LESLIE",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MA",
"license": "78256",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "J16437",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "078256",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3148289",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.