Healthcare Provider Details

I. General information

NPI: 1952898157
Provider Name (Legal Business Name): LEAH SHEPARDSON PEYTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11814 KING WILLIAM RD
AYLETT VA
23009-4103
US

IV. Provider business mailing address

8480 WINDSOR WALK LN
MECHANICSVILLE VA
23116-1802
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-3022
  • Fax:
Mailing address:
  • Phone: 804-513-9702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176050
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: