Healthcare Provider Details

I. General information

NPI: 1346175643
Provider Name (Legal Business Name): LEAH V PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6820 SOUTHPOINT PKWY
JACKSONVILLE FL
32216-6276
US

IV. Provider business mailing address

2305 COLDSTREAM PL
SAINT AUGUSTINE FL
32092-4730
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number060817832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: