Healthcare Provider Details

I. General information

NPI: 1588851828
Provider Name (Legal Business Name): LESLEIGH B SISSON CFOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 04/10/2021
Certification Date: 04/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-2251
US

IV. Provider business mailing address

400 SHADOW LN STE 110
LAS VEGAS NV
89106-4355
US

V. Phone/Fax

Practice location:
  • Phone: 702-384-1410
  • Fax: 702-384-0479
Mailing address:
  • Phone: 702-894-1410
  • Fax: 702-384-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: