Healthcare Provider Details

I. General information

NPI: 1669453528
Provider Name (Legal Business Name): LELAND DE EVOLI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SUMMIT CT SUITE 202
FISHKILL NY
12524-1348
US

IV. Provider business mailing address

2 SUMMIT CT SUITE 202
FISHKILL NY
12524-1348
US

V. Phone/Fax

Practice location:
  • Phone: 845-897-0009
  • Fax: 845-897-0009
Mailing address:
  • Phone: 845-897-0009
  • Fax: 845-897-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number125381-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number125381-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: