Provider Demographics
NPI:1013321876
Name:LEONARDI, MARY JEANNETTE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JEANNETTE
Last Name:LEONARDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:114 EDINBURGH PL
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9667
Mailing Address - Country:US
Mailing Address - Phone:864-431-5775
Mailing Address - Fax:
Practice Address - Street 1:3443 PELHAM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4178
Practice Address - Country:US
Practice Address - Phone:864-254-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2125363A00000X
NC0010-05053363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant