Provider Demographics
NPI:1013237254
Name:DUATO, SIMA LEAH (CAPPA, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:SIMA
Middle Name:LEAH
Last Name:DUATO
Suffix:
Gender:F
Credentials:CAPPA, IBCLC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:FLEISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IBCLC
Mailing Address - Street 1:14090 WINCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-1362
Mailing Address - Country:US
Mailing Address - Phone:347-661-8044
Mailing Address - Fax:
Practice Address - Street 1:14090 WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-1362
Practice Address - Country:US
Practice Address - Phone:347-661-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
11099905174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula