Healthcare Provider Details

I. General information

NPI: 1730293424
Provider Name (Legal Business Name): LEANNE LLADO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST APC 6
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST APC 6
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-9169
  • Fax: 401-444-2761
Mailing address:
  • Phone: 401-793-9169
  • Fax: 401-444-2761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051330
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00713
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: