Provider Demographics
NPI:1831779479
Name:LISTE LEON, MILADYS
Entity type:Individual
Prefix:
First Name:MILADYS
Middle Name:
Last Name:LISTE LEON
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 1:26055 SW 144TH AVE APT 216
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5654
Mailing Address - Country:US
Mailing Address - Phone:786-312-0394
Mailing Address - Fax:
Practice Address - Street 1:26055 SW 144TH AVE APT 216
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5654
Practice Address - Country:US
Practice Address - Phone:786-312-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11012227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty