Provider Demographics
NPI:1528268851
Name:HELLEBY-HARDY, LETICIA ESTELA (MD)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:ESTELA
Last Name:HELLEBY-HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0801
Mailing Address - Country:US
Mailing Address - Phone:336-765-8614
Mailing Address - Fax:336-765-8605
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-932-4075
Practice Address - Fax:540-932-5199
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01949208000000X
VA0101255245208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
147XCOtherBCBS
NC5908432Medicaid
147XCOtherBCBS