Healthcare Provider Details

I. General information

NPI: 1801521778
Provider Name (Legal Business Name): MISS LEAH SEBADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LEAH ROSE SEBADE

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 MARSHALL HOLLOW DR
NASHVILLE TN
37203-3066
US

IV. Provider business mailing address

333 MURFREESBORO PIKE
NASHVILLE TN
37210-2834
US

V. Phone/Fax

Practice location:
  • Phone: 309-824-8493
  • Fax:
Mailing address:
  • Phone: 615-248-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009984
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0008916
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: