Provider Demographics
NPI:1184383598
Name:MENELAS, LEANNA
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:MENELAS
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 1:31214 CLARIDGE PL
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5012
Mailing Address - Country:US
Mailing Address - Phone:240-478-1916
Mailing Address - Fax:
Practice Address - Street 1:2604 CYPRESS RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6311
Practice Address - Country:US
Practice Address - Phone:813-527-9638
Practice Address - Fax:813-867-7288
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician