Provider Demographics
NPI:1952869281
Name:LEAHEY, SHERYL ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:ANN
Last Name:LEAHEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 E. DUARTE RD.
Practice Address - Street 2:MAIN MEDICAL # 2112
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3000
Practice Address - Country:US
Practice Address - Phone:626-218-0237
Practice Address - Fax:626-218-0188
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily