Healthcare Provider Details

I. General information

NPI: 1649259623
Provider Name (Legal Business Name): DORIS MARGARITA LEEDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 BABCOCK ST NE STE 1
PALM BAY FL
32905-4616
US

IV. Provider business mailing address

PO BOX 1137
MELBOURNE FL
32902-1137
US

V. Phone/Fax

Practice location:
  • Phone: 321-676-5996
  • Fax: 321-676-5926
Mailing address:
  • Phone: 321-952-9696
  • Fax: 321-952-7937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME63747
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME63747
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: