Provider Demographics
NPI:1639140304
Name:DHANA, LEILA KHALED (MD)
Entity Type:Individual
Prefix:MS
First Name:LEILA
Middle Name:KHALED
Last Name:DHANA
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 1:2901 58TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-1326
Mailing Address - Country:US
Mailing Address - Phone:727-822-4300
Mailing Address - Fax:727-456-1399
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:SUITE #605
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-822-4300
Practice Address - Fax:727-456-1399
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266239600Medicaid
FL266239600Medicaid