Healthcare Provider Details

I. General information

NPI: 1801604707
Provider Name (Legal Business Name): LEESANG SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2024
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 EDGEWATER DR # 2761
ORLANDO FL
32804-6350
US

IV. Provider business mailing address

1317 EDGEWATER DR # 2761
ORLANDO FL
32804-6350
US

V. Phone/Fax

Practice location:
  • Phone: 561-598-9609
  • Fax:
Mailing address:
  • Phone: 561-598-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LASANDRA LEE
Title or Position: OWNER
Credential: APRN, FNP-C
Phone: 561-598-9609