Provider Demographics
NPI:1528685765
Name:TSEHAYE, LEILETY GETAHUN
Entity type:Individual
Prefix:
First Name:LEILETY
Middle Name:GETAHUN
Last Name:TSEHAYE
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 1:10062 E WYOMING PL APT 2217
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80247-6372
Mailing Address - Country:US
Mailing Address - Phone:720-499-5753
Mailing Address - Fax:
Practice Address - Street 1:10062 E WYOMING PL
Practice Address - Street 2:APARTMENT #2217
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80247-6380
Practice Address - Country:US
Practice Address - Phone:720-499-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-04
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133030654172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver