MEDICARE: EDDINA LEONARD

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	163W00000X	Registered Nurse	584196	NY

General Provider Information

NPI Number	:	1558745216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDINA LEONARD

Provider Business Mailing Address
First Line	:	5A HEMLOCK DR APT 95
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-2913
Country	:	US
Telephone Number	:	516-946-9167
Fax Number	:

Provider Business Practice Location Address
First Line	:	5A HEMLOCK DR APT 95
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-2913
Country	:	US
Telephone Number	:	516-946-9167
Fax Number	:

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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Directions to “ EDDINA LEONARD ” Practice Location

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