Provider Demographics
NPI:1932475027
Name:SIAFA, LEELA TODD
Entity Type:Individual
Prefix:
First Name:LEELA
Middle Name:TODD
Last Name:SIAFA
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 1:3861 BOGDON DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8142
Mailing Address - Country:US
Mailing Address - Phone:740-405-2715
Mailing Address - Fax:
Practice Address - Street 1:3861 BOGDON DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8142
Practice Address - Country:US
Practice Address - Phone:740-405-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134290164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse