Provider Demographics
NPI:1669726121
Name:LESSA JORDAO, LEIDE A (CSB)
Entity type:Individual
Prefix:MS
First Name:LEIDE
Middle Name:A
Last Name:LESSA JORDAO
Suffix:
Gender:F
Credentials:CSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COVE WAY UNIT 503
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5862
Mailing Address - Country:US
Mailing Address - Phone:617-543-8055
Mailing Address - Fax:
Practice Address - Street 1:200 COVE WAY UNIT 503
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5862
Practice Address - Country:US
Practice Address - Phone:617-543-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner