Healthcare Provider Details

I. General information

NPI: 1104757731
Provider Name (Legal Business Name): LEONIE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 121ST AVE
PEMBROKE PINES FL
33026-2555
US

IV. Provider business mailing address

1600 NW 121ST AVE
PEMBROKE PINES FL
33026-2555
US

V. Phone/Fax

Practice location:
  • Phone: 305-469-3482
  • Fax:
Mailing address:
  • Phone: 305-469-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: