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General NPI Number Information
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NPI Number | 1215256847
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Entity Type | Individual
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Provider Name | LEONARD GERARD SASSO P.A.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 11/13/2020
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Provider Practice Location Address
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Address Line | 3625 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4207
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Country | US
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Telephone | 904-702-6089
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Fax |
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Provider Business Mailing Address
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Address Line | 9191 R G SKINNER PKWY UNIT 703
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9662
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Country | US
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Telephone | 904-619-1386
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9105451
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | PA9105451
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License Number State | FL
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