Provider Demographics
NPI:1588410906
Name:FAVEDE, LEON FRANCIS II
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:FRANCIS
Last Name:FAVEDE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6657
Mailing Address - Country:US
Mailing Address - Phone:740-359-2188
Mailing Address - Fax:
Practice Address - Street 1:51 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1258
Practice Address - Country:US
Practice Address - Phone:814-341-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer