Provider Demographics
NPI:1598025256
Name:KASHANI, LEILA (DO)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:KASHANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:
Other - Last Name:KASHANI-GHARAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 KRESSON RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2604
Mailing Address - Country:US
Mailing Address - Phone:856-795-3320
Mailing Address - Fax:856-795-1213
Practice Address - Street 1:821 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2102
Practice Address - Country:US
Practice Address - Phone:660-826-4774
Practice Address - Fax:660-827-8992
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09751400208000000X
MO2017044049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics