Provider Demographics
NPI:1093232357
Name:ZELLERS, LEA MICHELLE (MS ED, MS SPED)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:MICHELLE
Last Name:ZELLERS
Suffix:
Gender:F
Credentials:MS ED, MS SPED
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:MICHELLE
Other - Last Name:FLEISCHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS ED, MS SPED
Mailing Address - Street 1:10818 QUEENS BLVD STE 4A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-1801
Practice Address - Country:US
Practice Address - Phone:631-922-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2529567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty