Healthcare Provider Details

I. General information

NPI: 1427963420
Provider Name (Legal Business Name): MACKENZIE LEONARD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 GARDENSIDE LN
SHELBURNE VT
05482-6541
US

IV. Provider business mailing address

251 GARDENSIDE LN
SHELBURNE VT
05482-6541
US

V. Phone/Fax

Practice location:
  • Phone: 802-338-5890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: