Healthcare Provider Details

I. General information

NPI: 1063744209
Provider Name (Legal Business Name): TAKESHA LA'SHAWN LEONARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 MAIN ST STE 466
BUFFALO NY
14214-2135
US

IV. Provider business mailing address

184 BARTON ST
BUFFALO NY
14213-1573
US

V. Phone/Fax

Practice location:
  • Phone: 716-260-9320
  • Fax:
Mailing address:
  • Phone: 716-881-6191
  • Fax: 716-881-6247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP033342
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404581
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP033342
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336180-1
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP033342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: