Provider Demographics
NPI:1477725042
Name:TIEN, LESLIE (MS, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:TIEN
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SEYMOUR ST STE 125
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5507
Mailing Address - Country:US
Mailing Address - Phone:959-599-3526
Mailing Address - Fax:608-696-5140
Practice Address - Street 1:85 SEYMOUR ST STE 125
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5507
Practice Address - Country:US
Practice Address - Phone:959-599-3526
Practice Address - Fax:608-696-5140
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001934363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant