Provider Demographics
NPI:1790898401
Name:LEONARD-PASLEY, KEVIN R (PA)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:R
Last Name:LEONARD-PASLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:230-203-4160
Mailing Address - Fax:203-848-2484
Practice Address - Street 1:2543 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1809
Practice Address - Country:US
Practice Address - Phone:203-230-4160
Practice Address - Fax:203-848-2484
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000936363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P36973Medicare UPIN