Provider Demographics
NPI:1720238603
Name:BLANDON, LEONEL DEJESUS (PA- C)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:DEJESUS
Last Name:BLANDON
Suffix:
Gender:M
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 SW 140TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3051
Mailing Address - Country:US
Mailing Address - Phone:305-794-4191
Mailing Address - Fax:
Practice Address - Street 1:7507 SW 140TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3051
Practice Address - Country:US
Practice Address - Phone:305-794-4191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical