Provider Demographics
NPI:1194707596
Name:SAPORITO, LEAH A (PA-C)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:SAPORITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 FOREST HILL BLVD. SUITE 230
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-798-6600
Mailing Address - Fax:561-615-1958
Practice Address - Street 1:10115 FOREST HILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6178
Practice Address - Country:US
Practice Address - Phone:561-670-2010
Practice Address - Fax:561-670-2319
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103511363A00000X, 363AM0700X
FLPA 9103511363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292522200Medicaid
FL292522200Medicaid
FLU6590ZMedicare PIN