Provider Demographics
NPI:1316006588
Name:LEAVELLE, LEE BARRY (PA)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:BARRY
Last Name:LEAVELLE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:107 WEST 4TH STREET
Mailing Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:914-699-0837
Practice Address - Street 1:107 W 4TH STREET
Practice Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CTR
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-699-0837
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-11-05
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Provider Licenses
StateLicense IDTaxonomies
NY0003531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant