MEDICARE: TODD A SLEZAK CRNP

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
1	363L00000X	Nurse Practitioner	SP008382	PA
2	363LF0000X	Family Nurse Practitioner	SP008382	PA

General Provider Information

NPI Number	:	1154364990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD A SLEZAK CRNP

Provider Business Mailing Address
First Line	:	339 OLD HAYMAKER RD STE 209
Second Line	:
City	:	MONROEVILLE
State	:	PA
Zip	:	15146-1684
Country	:	US
Telephone Number	:	724-850-8118
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 WILDLIFE LODGE RD STE 1
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-3652
Country	:	US
Telephone Number	:	243-359-7337
Fax Number	:	243-359-7347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	10/08/2024

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