Healthcare Provider Details

I. General information

NPI: 1396832440
Provider Name (Legal Business Name): LEIGH A BREZNAY PA-C, MPAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 MURRELL RD
MELBOURNE FL
32940-7999
US

IV. Provider business mailing address

2926 MONDAVI DR
ROCKLEDGE FL
32955-5188
US

V. Phone/Fax

Practice location:
  • Phone: 321-242-8790
  • Fax: 321-751-9362
Mailing address:
  • Phone: 321-242-8790
  • Fax: 321-751-9362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2496
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAX00007028
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: