Provider Demographics
NPI:1093932006
Name:YOUEL, LEISA (MD)
Entity Type:Individual
Prefix:
First Name:LEISA
Middle Name:
Last Name:YOUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 LAKE FRONT LN
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4827
Mailing Address - Country:US
Mailing Address - Phone:407-788-9001
Mailing Address - Fax:
Practice Address - Street 1:1005 LAKE FRONT LN
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4827
Practice Address - Country:US
Practice Address - Phone:407-788-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist