Healthcare Provider Details

I. General information

NPI: 1427997121
Provider Name (Legal Business Name): ASHTYN BROOKE LEATHERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 JONES RD
AUBURNDALE FL
33823-2403
US

IV. Provider business mailing address

277 JONES RD
AUBURNDALE FL
33823-2403
US

V. Phone/Fax

Practice location:
  • Phone: 863-712-3771
  • Fax:
Mailing address:
  • Phone: 863-712-3771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI8099
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: