Provider Demographics
NPI:1104071265
Name:LESLIE, MAYRI SAGADY (CNM)
Entity type:Individual
Prefix:
First Name:MAYRI
Middle Name:SAGADY
Last Name:LESLIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHURCH ST S
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1703
Mailing Address - Country:US
Mailing Address - Phone:619-743-4989
Mailing Address - Fax:203-737-2597
Practice Address - Street 1:100 CHURCH ST S
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1703
Practice Address - Country:US
Practice Address - Phone:619-743-4989
Practice Address - Fax:203-737-2597
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001206629163W00000X
CA504434163W00000X
VA0024167388367A00000X
DCRN1011287367A00000X
CA1274367A00000X
CT336367A00000X
MDAC00567367A00000X
CT89442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse