Healthcare Provider Details

I. General information

NPI: 1679391395
Provider Name (Legal Business Name): SIERRA LEGEER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD SUITE 2E99
NEWARK DE
19718-2200
US

IV. Provider business mailing address

1221 S BROAD ST APT 302
PHILADELPHIA PA
19147-4443
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-5982
  • Fax: 302-733-6081
Mailing address:
  • Phone: 904-625-0443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0012178
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: