Provider Demographics
NPI:1316141922
Name:LYLES-DELEON, LEISA (AUD)
Entity type:Individual
Prefix:DR
First Name:LEISA
Middle Name:
Last Name:LYLES-DELEON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:LEISA
Other - Middle Name:LYLES
Other - Last Name:DELEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUD
Mailing Address - Street 1:3702 ETON DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6848
Mailing Address - Country:US
Mailing Address - Phone:202-390-5012
Mailing Address - Fax:
Practice Address - Street 1:3301 NEW MEXICO AVE NW
Practice Address - Street 2:STE. 125
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3622
Practice Address - Country:US
Practice Address - Phone:202-621-6374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC230886YGFFOtherMEDICARE