Provider Demographics
NPI:1811438419
Name:LEITE, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:LEITE
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 1:408 S K ST
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-4510
Mailing Address - Country:US
Mailing Address - Phone:361-932-3052
Mailing Address - Fax:
Practice Address - Street 1:408 S K ST
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-4510
Practice Address - Country:US
Practice Address - Phone:361-932-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator