Provider Demographics
NPI:1679991541
Name:MILLER, LESLIE DIANE (MSED)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E BELLE TERRE AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6507
Mailing Address - Country:US
Mailing Address - Phone:631-741-2307
Mailing Address - Fax:
Practice Address - Street 1:1 E BELLE TERRE AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6507
Practice Address - Country:US
Practice Address - Phone:631-741-2307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist