Provider Demographics
NPI:1609309491
Name:LESSARD, ANNE-SOPHIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANNE-SOPHIE
Middle Name:
Last Name:LESSARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH ST
Mailing Address - Street 2:CRB 4TH FLOOR
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136
Mailing Address - Country:US
Mailing Address - Phone:305-243-4500
Mailing Address - Fax:305-243-4535
Practice Address - Street 1:1120 NW 14TH ST
Practice Address - Street 2:CRB 4TH FLOOR
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136
Practice Address - Country:US
Practice Address - Phone:305-243-4500
Practice Address - Fax:305-243-4535
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2018-06-28
Deactivation Date:2017-11-09
Deactivation Code:
Reactivation Date:2018-06-28
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME1359762086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program