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General NPI Number Information
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NPI Number | 1760045694
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Entity Type | Individual
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Provider Name | MADISON LEIGH COLLINS MD
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Gender | Female
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 02/03/2024
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Provider Practice Location Address
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Address Line | 843 N INDIAN RIVER DR
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City | COCOA
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State | FL
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Zip | 32922-7530
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Country | US
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Telephone | 561-319-4523
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Fax |
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Provider Business Mailing Address
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Address Line | 843 N INDIAN RIVER DR
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City | COCOA
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State | FL
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Zip | 32922-7530
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Country | US
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Telephone | 561-319-4523
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 318752
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 162271
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License Number State | FL
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