Healthcare Provider Details

I. General information

NPI: 1144827999
Provider Name (Legal Business Name): LESLEY A EGGERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLEY A DESTEFANO PA-C

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 S 9TH ST STE 1
LEHIGHTON PA
18235-2517
US

IV. Provider business mailing address

575 S 9TH ST STE 1
LEHIGHTON PA
18235-2517
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-5210
  • Fax: 866-568-6561
Mailing address:
  • Phone: 484-526-5210
  • Fax: 866-568-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA005287
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: