Healthcare Provider Details

I. General information

NPI: 1811124274
Provider Name (Legal Business Name): CANDICE MARIE LEACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 SAWGRASS DR STE 120
ROCHESTER NY
14620-4654
US

IV. Provider business mailing address

601 ELMWOOD AVE DIVISION OF PLASTIC SURGERY
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME29368
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number325087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: