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NPI Code Detail

MEDICARE: AVERY MADISON LEACH

MEDICARE: AVERY MADISON LEACH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantFL

General Provider Information

NPI Number : 1104775386
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY MADISON LEACH
Provider Business Mailing Address
First Line : 1861 SUMMER WALK CIR
Second Line :
City : SARASOTA
State : FL
Zip : 34232-2916
Country : US
Telephone Number : 941-928-8163
Fax Number :
Provider Business Practice Location Address
First Line : 11300 NE 2ND AVE
Second Line :
City : MIAMI SHORES
State : FL
Zip : 33161-6628
Country : US
Telephone Number : 305-899-3130
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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Directions to “ AVERY MADISON LEACH ” Practice Location

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