Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | X010752 | NY |
NPI | 1629296835 |
---|---|
Provider Name | Dr. Shannon Leon |
First Address | Jericho, NY 11753-2303 |
Second Address | Jericho, NY 11753 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 20/02/2009 |