Provider Demographics
NPI:1861377731
Name:LEON, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LEON
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 1:3429 LONG SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-4243
Mailing Address - Country:US
Mailing Address - Phone:315-415-5191
Mailing Address - Fax:
Practice Address - Street 1:3429 LONG SHADOW DR
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-4243
Practice Address - Country:US
Practice Address - Phone:315-415-5191
Practice Address - Fax:315-415-5191
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist