Provider Demographics
NPI:1790151777
Name:LEDANE, CARLA (MA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:LEDANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 US 27 S
Mailing Address - Street 2:SUITE 206
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-7744
Mailing Address - Country:US
Mailing Address - Phone:863-452-0634
Mailing Address - Fax:863-452-0545
Practice Address - Street 1:2523 US 27 S
Practice Address - Street 2:SUITE 206
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-7744
Practice Address - Country:US
Practice Address - Phone:863-452-0634
Practice Address - Fax:863-452-0545
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS