Provider Demographics
NPI:1730997297
Name:MCLEOD, TANEKA D (LPN)
Entity type:Individual
Prefix:
First Name:TANEKA
Middle Name:D
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13047 229TH ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-1838
Mailing Address - Country:US
Mailing Address - Phone:718-734-7853
Mailing Address - Fax:
Practice Address - Street 1:72 GUY LOMBARDO AVE STE 2
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3742
Practice Address - Country:US
Practice Address - Phone:516-226-3951
Practice Address - Fax:516-223-5000
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35136401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse