Provider Demographics
NPI:1558330365
Name:LEYO DUPONT, SANDRA A (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:LEYO DUPONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:A
Other - Last Name:SCHAFFRANEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1055 N LA CANADA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-3700
Mailing Address - Country:US
Mailing Address - Phone:520-589-2039
Mailing Address - Fax:520-589-2039
Practice Address - Street 1:1055 N LA CANADA DR STE 101
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3700
Practice Address - Country:US
Practice Address - Phone:520-589-2039
Practice Address - Fax:520-589-2039
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26931207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791659Medicaid
AZP00407772OtherRAILROAD MEDICARE
H84757Medicare UPIN
AZZ130611Medicare PIN
AZP00407772OtherRAILROAD MEDICARE
AZ119979Medicare PIN
AZZ131410Medicare PIN
AZ111243Medicare PIN