Provider Demographics
NPI:1508859547
Name:AVERY, K. LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:K.
Middle Name:LESLIE
Last Name:AVERY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:DEPT OF PEDIATRIC CRITICAL CARE SHANDS
Mailing Address - Street 2:1600 SW ARCHER RD, STE. 10-504, BOX 100296
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-265-0462
Mailing Address - Fax:352-265-0443
Practice Address - Street 1:DEPT OF PEDIATRIC CRITICAL CARE SHANDS
Practice Address - Street 2:1600 SW ARCHER RD, STE. 10-504, BOX 100296
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-265-0462
Practice Address - Fax:352-265-0443
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-10-07
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Provider Licenses
StateLicense IDTaxonomies
FLME1157252080P0203X
NV113162080P0203X
CAA679292080P0203X
CODR.00718962080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008799300Medicaid
NV100863Medicare ID - Type Unspecified
FLHF981ZMedicare PIN
FL008799300Medicaid