Provider Demographics
NPI:1689038036
Name:LEYDA, MICHELE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LEYDA
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 1:435 DEEMS PARK RD
Mailing Address - Street 2:
Mailing Address - City:COAL CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15423-1336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:435 DEEMS PARK RD
Practice Address - Street 2:
Practice Address - City:COAL CENTER
Practice Address - State:PA
Practice Address - Zip Code:15423-1336
Practice Address - Country:US
Practice Address - Phone:724-809-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN572873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse