Healthcare Provider Details

I. General information

NPI: 1992660138
Provider Name (Legal Business Name): DANYELLE LEADERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WILCOX ST
CASTLE ROCK CO
80104-1992
US

IV. Provider business mailing address

5429 S WACO ST # 202C
CENTENNIAL CO
80015-2653
US

V. Phone/Fax

Practice location:
  • Phone: 561-350-9784
  • Fax:
Mailing address:
  • Phone: 561-350-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1001481
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: