Healthcare Provider Details

I. General information

NPI: 1194860627
Provider Name (Legal Business Name): MISS LEANNE M SOBILO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10714 NORTH RD
PERRYSBURG NY
14129-9746
US

IV. Provider business mailing address

6869 MINUTEMAN TRL
DERBY NY
14047-9578
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-1049
  • Fax: 716-532-0679
Mailing address:
  • Phone: 716-947-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0141041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: