Provider Demographics
NPI:1497513634
Name:NOVO, LEAH M (PA STUDENT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:NOVO
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 TERRANCE BLVD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-3610
Mailing Address - Country:US
Mailing Address - Phone:716-683-4196
Mailing Address - Fax:716-646-0763
Practice Address - Street 1:571 TERRANCE BLVD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-3610
Practice Address - Country:US
Practice Address - Phone:716-683-4196
Practice Address - Fax:716-646-0763
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program