Provider Demographics
NPI:1740060094
Name:LESLIE, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:LESLIE
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 1:2760 SAND LENDS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113
Mailing Address - Country:US
Mailing Address - Phone:786-400-3227
Mailing Address - Fax:
Practice Address - Street 1:4530 WISCONSIN AVE NW STE 300
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4606
Practice Address - Country:US
Practice Address - Phone:202-465-4364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator