Provider Demographics
NPI:1518365022
Name:DE SHAY, LEAH (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:DE SHAY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21832 S EMBASSY AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1739
Mailing Address - Country:US
Mailing Address - Phone:714-884-9272
Mailing Address - Fax:
Practice Address - Street 1:2700 BELLFLOWER BLVD
Practice Address - Street 2:#112
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:714-884-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-67984163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant