Provider Demographics
NPI:1144755331
Name:BANDA, LEAH
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BANDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 KENT AVE
Mailing Address - Street 2:4-D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-6635
Mailing Address - Country:US
Mailing Address - Phone:718-496-0682
Mailing Address - Fax:
Practice Address - Street 1:535 KENT AVE
Practice Address - Street 2:4-D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-6635
Practice Address - Country:US
Practice Address - Phone:718-496-0682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator