Provider Demographics
NPI:1689545915
Name:FERNANDEZ, LESLIE
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-2414
Mailing Address - Country:US
Mailing Address - Phone:516-708-0243
Mailing Address - Fax:631-208-4462
Practice Address - Street 1:135 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-2414
Practice Address - Country:US
Practice Address - Phone:516-708-0243
Practice Address - Fax:631-208-4462
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034475363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical