Provider Demographics
NPI:1306862602
Name:LLENADO, JEANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:
Last Name:LLENADO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CRESCENT DR FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112-1016
Mailing Address - Country:US
Mailing Address - Phone:215-503-7124
Mailing Address - Fax:215-503-3191
Practice Address - Street 1:3 CRESCENT DR FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112-1016
Practice Address - Country:US
Practice Address - Phone:215-503-7124
Practice Address - Fax:215-503-3191
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-011077-L208600000X, 208800000X
NJ25MB06433200208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001853497Medicaid
NJ8536201Medicaid