Healthcare Provider Details

I. General information

NPI: 1730001173
Provider Name (Legal Business Name): MARISSA ALEXIS LESKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 S UNIVERSITY DR
DAVIE FL
33328-2000
US

IV. Provider business mailing address

3476 S UNIVERSITY DR FLOOR 3 NICU
DAVIE FL
33328
US

V. Phone/Fax

Practice location:
  • Phone: 954-475-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: