Healthcare Provider Details

I. General information

NPI: 1538908793
Provider Name (Legal Business Name): MRS. SHARON LYNN LEYDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MCCORMICK DR
LARGO MD
20774-5329
US

IV. Provider business mailing address

12506 CHELTON LANE
BOWIE MD
20715
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-9489
  • Fax:
Mailing address:
  • Phone: 301-262-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: