Provider Demographics
NPI:1043192602
Name:LEROY, JESSICA THERESA (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:THERESA
Last Name:LEROY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:THERESA
Other - Last Name:BECERRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:24 ARROWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1545
Mailing Address - Country:US
Mailing Address - Phone:917-217-0686
Mailing Address - Fax:
Practice Address - Street 1:850 HICKSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1300
Practice Address - Country:US
Practice Address - Phone:516-798-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY357410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily