Provider Demographics
NPI:1831132638
Name:NEVILLE, LEAHA J (DPM)
Entity Type:Individual
Prefix:
First Name:LEAHA
Middle Name:J
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112727
Mailing Address - Street 2:UF ORTHOPEDICS AND SPORTS MEDICINE INSTITUTE
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611
Mailing Address - Country:US
Mailing Address - Phone:352-273-7394
Mailing Address - Fax:352-273-7388
Practice Address - Street 1:49 8TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6020
Practice Address - Country:US
Practice Address - Phone:239-436-1999
Practice Address - Fax:236-436-3788
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3148213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020786800Medicaid
U7945YOtherMEDICARE PTAN
U7945YOtherMEDICARE PTAN
U84851Medicare UPIN