Provider Demographics
NPI:1932423712
Name:JAFARACE, LESLIE E (MSOM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:JAFARACE
Suffix:
Gender:F
Credentials:MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14323 OCEAN HWY
Mailing Address - Street 2:SUITE 4143
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-4817
Mailing Address - Country:US
Mailing Address - Phone:843-455-4228
Mailing Address - Fax:
Practice Address - Street 1:14323 OCEAN HIGHWAY
Practice Address - Street 2:SUITE 4143
Practice Address - City:PAWLEY'S ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:843-455-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist