Provider Demographics
NPI:1841033610
Name:ALLEN, LEKIESHA SOPHIA
Entity type:Individual
Prefix:
First Name:LEKIESHA
Middle Name:SOPHIA
Last Name:ALLEN
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 1:2505 S GROSS ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-3113
Mailing Address - Country:US
Mailing Address - Phone:215-307-1950
Mailing Address - Fax:
Practice Address - Street 1:2505 S GROSS ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-3113
Practice Address - Country:US
Practice Address - Phone:215-307-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor