Healthcare Provider Details

I. General information

NPI: 1659292845
Provider Name (Legal Business Name): JEYDALEE LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2980 PUERTO RICO 5180
PONCE PR
00730
US

IV. Provider business mailing address

URB. VILLA ESPERANZA CALLE 3#7
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-7691
  • Fax:
Mailing address:
  • Phone: 939-247-5958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number9060
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: