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General NPI Number Information
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NPI Number | 1114161239
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Entity Type | Individual
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Provider Name | AUDRA A LEBOO MBCHB
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Gender | Female
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Dates
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Enumeration Date | 04/21/2009
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 23 ONTARIO ST
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City | HONEOYE FALLS
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State | NY
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Zip | 14472-1149
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Country | US
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Telephone | 585-624-2121
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Fax | 585-624-7283
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Provider Business Mailing Address
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Address Line | 300 WEST AVE
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City | BROCKPORT
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State | NY
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Zip | 14420-1118
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Country | US
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Telephone | 585-637-3905
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Fax | 585-637-4990
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 60 266255
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License Number State | NY
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