Provider Demographics
NPI:1801521778
Name:SEBADE, LEAH
Entity type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:
Last Name:SEBADE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LEAH
Other - Middle Name:ROSE
Other - Last Name:SEBADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:333 MURFREESBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2834
Mailing Address - Country:US
Mailing Address - Phone:615-248-1225
Mailing Address - Fax:
Practice Address - Street 1:1610 MARSHALL HOLLOW DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3066
Practice Address - Country:US
Practice Address - Phone:309-824-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL085009984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program