Provider Demographics
NPI:1154364990
Name:SLEZAK, TODD A (CRNP)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:SLEZAK
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 OLD HAYMAKER RD STE 209
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1684
Mailing Address - Country:US
Mailing Address - Phone:724-850-8118
Mailing Address - Fax:
Practice Address - Street 1:1600 WILDLIFE LODGE RD STE 1
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-3652
Practice Address - Country:US
Practice Address - Phone:243-359-7337
Practice Address - Fax:243-359-7347
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008382363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27245Medicare UPIN
084750Medicare ID - Type Unspecified