{
"Npi": {
"NPI": "1669817201",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SEALY",
"FirstName": "LESA",
"MiddleName": "ROMONA",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NORIEGA",
"OtherFirstName": "LESA",
"OtherMiddleName": "ROMONA",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "ADULT CARE PROVIDER",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "15 MADRE DE DIOS ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PUNTA GORDA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33983-4254",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "941-629-4934",
"MailingAddressFaxNumber": "941-629-4934",
"FirstLinePracticeLocationAddress": "15 MADRE DE DIOS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PUNTA GORDA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33983-4254",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "941-629-4934",
"PracticeLocationAddressFaxNumber": "941-629-4934",
"EnumerationDate": "05/09/2013",
"LastUpdateDate": "05/09/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "311ZA0620X",
"TaxonomyName": "Adult Care Home Facility",
"LicenseNumber": "6906321",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}