Provider Demographics
NPI:1477041606
Name:ULIANO, LEAH ROSE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ROSE
Last Name:ULIANO
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 1:22 GRIFFEN CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1432
Mailing Address - Country:US
Mailing Address - Phone:631-793-2154
Mailing Address - Fax:631-793-2154
Practice Address - Street 1:22 GRIFFEN CT
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1432
Practice Address - Country:US
Practice Address - Phone:631-793-2154
Practice Address - Fax:631-793-2154
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3735734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist