Healthcare Provider Details

I. General information

NPI: 1245603265
Provider Name (Legal Business Name): LESLIE YEDOR L.AC., PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S FRONTAGE RD W
VAIL CO
81657-5038
US

IV. Provider business mailing address

PO BOX 40000
VAIL CO
81658-7520
US

V. Phone/Fax

Practice location:
  • Phone: 805-338-6905
  • Fax:
Mailing address:
  • Phone: 970-476-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002343
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: