Provider Demographics
NPI:1194127522
Name:RIANO GALEANO, LEIDY
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:
Last Name:RIANO GALEANO
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 1:1351 ALAFAYA TRL STE 1017
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9100
Mailing Address - Country:US
Mailing Address - Phone:407-519-0634
Mailing Address - Fax:321-415-1071
Practice Address - Street 1:1351 ALAFAYA TRL STE 1017
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9100
Practice Address - Country:US
Practice Address - Phone:407-519-0634
Practice Address - Fax:321-415-1071
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-17
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20760122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice