Provider Demographics
NPI:1891153169
Name:LEON HENDLEY MD OF VERO BEACH PA
Entity Type:Organization
Organization Name:LEON HENDLEY MD OF VERO BEACH PA
Other - Org Name:HENDLEY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HENDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-770-4911
Mailing Address - Street 1:426 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1542
Mailing Address - Country:US
Mailing Address - Phone:772-633-7794
Mailing Address - Fax:772-205-2070
Practice Address - Street 1:1300 36TH ST STE 1C
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4898
Practice Address - Country:US
Practice Address - Phone:772-770-4911
Practice Address - Fax:772-569-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044169261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0044169OtherMEDICAL LICENSE