=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003729252
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMELIA MARIA LEO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 PLEASANT ST
-----------------------------------------------------
City | EAST LONGMEADOW
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01028-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-525-0955
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 BELMONT AVE
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | DH12119
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------