Provider Demographics
NPI:1942659784
Name:DE LEON, AYAM II (LPN)
Entity Type:Individual
Prefix:
First Name:AYAM
Middle Name:
Last Name:DE LEON
Suffix:II
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 CARDINAL RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-5201
Mailing Address - Country:US
Mailing Address - Phone:347-981-2230
Mailing Address - Fax:
Practice Address - Street 1:637 CARDINAL RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-5201
Practice Address - Country:US
Practice Address - Phone:347-981-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse