Provider Demographics
NPI:1851992135
Name:LEACH, SHONDA LATOYA
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:LATOYA
Last Name:LEACH
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 1:821 WESTMINISTER WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-2015
Mailing Address - Country:US
Mailing Address - Phone:846-203-6631
Mailing Address - Fax:
Practice Address - Street 1:821 WESTMINISTER WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25314-2015
Practice Address - Country:US
Practice Address - Phone:846-203-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant