Provider Demographics
NPI:1447717582
Name:YOUSSEFZADEH, LEORA (PA-C, CDCES)
Entity type:Individual
Prefix:
First Name:LEORA
Middle Name:
Last Name:YOUSSEFZADEH
Suffix:
Gender:F
Credentials:PA-C, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1591
Mailing Address - Country:US
Mailing Address - Phone:516-589-1089
Mailing Address - Fax:
Practice Address - Street 1:555 TAXTER RD FL 3
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-2336
Practice Address - Country:US
Practice Address - Phone:914-457-4130
Practice Address - Fax:914-909-1461
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022912-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical