Provider Demographics
NPI:1609027655
Name:LELIS, NIDA LAIMUTE
Entity Type:Individual
Prefix:
First Name:NIDA
Middle Name:LAIMUTE
Last Name:LELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 TORREY PINE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-2989
Mailing Address - Country:US
Mailing Address - Phone:585-737-4552
Mailing Address - Fax:
Practice Address - Street 1:143 TORREY PINE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-2989
Practice Address - Country:US
Practice Address - Phone:585-368-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009806-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist