Provider Demographics
NPI:1669723029
Name:SALINE, LEENA CHACKO (DO)
Entity type:Individual
Prefix:DR
First Name:LEENA
Middle Name:CHACKO
Last Name:SALINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:LEENA
Other - Middle Name:
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:928B MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6706
Mailing Address - Country:US
Mailing Address - Phone:850-357-8151
Mailing Address - Fax:850-362-6060
Practice Address - Street 1:928B MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-357-8151
Practice Address - Fax:850-362-6060
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15786207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology