Provider Demographics
NPI:1700653227
Name:MURRELL, LESHAWNA STEPHANIE
Entity Type:Individual
Prefix:
First Name:LESHAWNA
Middle Name:STEPHANIE
Last Name:MURRELL
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 1:1 POMPERAUG OFFICE PARK STE 103
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2295
Mailing Address - Country:US
Mailing Address - Phone:203-558-1143
Mailing Address - Fax:860-398-9080
Practice Address - Street 1:1 POMPERAUG OFFICE PARK STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2295
Practice Address - Country:US
Practice Address - Phone:203-558-1143
Practice Address - Fax:860-398-9080
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12674363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health