Provider Demographics
NPI:1578790010
Name:LEAHY, JADA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JADA
Middle Name:MICHELLE
Last Name:LEAHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JADA
Other - Middle Name:MICHELLE
Other - Last Name:AIKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-437-8810
Mailing Address - Fax:
Practice Address - Street 1:1717 N E ST STE 205
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6336
Practice Address - Country:US
Practice Address - Phone:850-437-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248406208600000X
FLME1320612086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery