MEDICARE: JENISSA DENEE LEITE DA SILVA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9113699	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OE838	OTHER	FL	MEDICARE HF

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023615507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENISSA DENEE LEITE DA SILVA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 935921
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-5921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 MEMORIAL MEDICAL PKWY STE 2811
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-5999
Country	:	US
Telephone Number	:	386-586-1955
Fax Number	:	386-586-1959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	03/25/2026

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Directions to “ JENISSA DENEE LEITE DA SILVA PA-C” Practice Location

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