Provider Demographics
NPI:1073547758
Name:LEONARD, SAUNDRA E (RN)
Entity Type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:E
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:S.
Other - Middle Name:ELAINE
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2319 ST. MATTHEWS ROAD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118
Mailing Address - Country:US
Mailing Address - Phone:803-536-1571
Mailing Address - Fax:803-536-1463
Practice Address - Street 1:112 GUESS LN
Practice Address - Street 2:
Practice Address - City:ST MATTHEWS
Practice Address - State:SC
Practice Address - Zip Code:29135-8410
Practice Address - Country:US
Practice Address - Phone:803-536-1571
Practice Address - Fax:803-536-1463
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49570163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC413093Medicaid
3345Medicare ID - Type Unspecified