Healthcare Provider Details

I. General information

NPI: 1417869827
Provider Name (Legal Business Name): TIFFANY K LEEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 E 17TH ST # 1
BROOKLYN NY
11230-6052
US

IV. Provider business mailing address

1329 E 17TH ST # 1
BROOKLYN NY
11230-6052
US

V. Phone/Fax

Practice location:
  • Phone: 716-340-4380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: