Healthcare Provider Details

I. General information

NPI: 1891459087
Provider Name (Legal Business Name): LINDSEY LEASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 ENGINEERING ST
MELBOURNE FL
32901
US

IV. Provider business mailing address

150 W UNIVERSITY BLVD
MELBOURNE FL
32901-8995
US

V. Phone/Fax

Practice location:
  • Phone: 321-674-8106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: