Provider Demographics
NPI:1104674993
Name:LEON D ANGELO, LEIDYS
Entity type:Individual
Prefix:
First Name:LEIDYS
Middle Name:
Last Name:LEON D ANGELO
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 1:536SW 47TH ST
Mailing Address - Street 2:APT B
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914
Mailing Address - Country:US
Mailing Address - Phone:239-314-6677
Mailing Address - Fax:
Practice Address - Street 1:536SW 47TH ST
Practice Address - Street 2:APT B
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914
Practice Address - Country:US
Practice Address - Phone:239-314-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-343912106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician