Provider Demographics
NPI:1679970289
Name:LEFORT, AUBREY
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:LEFORT
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 1:6221 STEINWAY DR
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-3404
Mailing Address - Country:US
Mailing Address - Phone:315-278-5335
Mailing Address - Fax:
Practice Address - Street 1:68 S SERVICE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2354
Practice Address - Country:US
Practice Address - Phone:516-945-3347
Practice Address - Fax:516-945-3131
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN643574367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered