Healthcare Provider Details

I. General information

NPI: 1609945997
Provider Name (Legal Business Name): LEAMOR DE LEON BUENASEDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 FAYETTEVILLE RD
RAEFORD NC
28376-8058
US

IV. Provider business mailing address

333 W SUMMERCHASE DR
FAYETTEVILLE NC
28311-2970
US

V. Phone/Fax

Practice location:
  • Phone: 910-848-5437
  • Fax: 910-848-5439
Mailing address:
  • Phone: 910-717-0348
  • Fax: 910-848-5439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200601348
License Number StateNC

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: