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General NPI Number Information
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NPI Number | 1164836490
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Entity Type | Individual
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Provider Name | DEVON E LEAHY PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/14/2014
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 800 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6130
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Country | US
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Telephone | 215-662-3340
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Fax | 215-349-5890
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Provider Business Mailing Address
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Address Line | 800 SPRUCE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19107-6130
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Country | US
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Telephone | 215-662-3340
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Fax | 215-349-5890
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00568200
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA061194
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License Number State | PA
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