Healthcare Provider Details

I. General information

NPI: 1407185739
Provider Name (Legal Business Name): LESLIE CINDY DERAT AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 12/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5625 POPLAR AVE
MEMPHIS TN
38119-3815
US

IV. Provider business mailing address

2146 SETON PL
GERMANTOWN TN
38139-4243
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-0147
  • Fax:
Mailing address:
  • Phone: 901-433-9549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0000001545
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number0000001545
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: