Provider Demographics
NPI:1821698614
Name:LEON OREILLY, LEIDYS
Entity Type:Individual
Prefix:
First Name:LEIDYS
Middle Name:
Last Name:LEON OREILLY
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 1:5031 NW 168TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-4139
Mailing Address - Country:US
Mailing Address - Phone:239-404-3025
Mailing Address - Fax:
Practice Address - Street 1:5031 NW 168TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-4139
Practice Address - Country:US
Practice Address - Phone:239-404-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-121138106S00000X
106S00000X
FLRBT-20-121138106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician