Provider Demographics
NPI:1730504952
Name:BIECKER, MATTHEW SHAWN
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SHAWN
Last Name:BIECKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COLBY DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1539
Mailing Address - Country:US
Mailing Address - Phone:352-613-5919
Mailing Address - Fax:
Practice Address - Street 1:301 DANIEL TRENT WAY
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6098
Practice Address - Country:US
Practice Address - Phone:352-613-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman