Healthcare Provider Details

I. General information

NPI: 1447612726
Provider Name (Legal Business Name): LESLEY BOOHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MILLER RD
FAIRLAWN OH
44333-3702
US

IV. Provider business mailing address

5806 ROSEMONT WAY
MEDINA OH
44256-3567
US

V. Phone/Fax

Practice location:
  • Phone: 330-836-9721
  • Fax:
Mailing address:
  • Phone: 440-537-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.136729
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: