Healthcare Provider Details

I. General information

NPI: 1114422482
Provider Name (Legal Business Name): ALEXANDRA DE LEO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD STE 4102
GAINESVILLE FL
32610
US

IV. Provider business mailing address

PO BOX 100265
GAINESVILLE FL
32610-0265
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0239
  • Fax:
Mailing address:
  • Phone: 352-265-0239
  • Fax: 352-265-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME163729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: