Organization
SOPHIA V. LEONIDA, MD PC
Active
Other names
Stationhouse Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN MELITO (OFFICE MANAGER)
(203) 375-9350
Entity
Organization
Contact information
Practice address
2228 BLACK ROCK TPKE, SUITE 211, FAIRFIELD, CT 06825-3237
(203) 375-9350
(203) 375-8013
Mailing address
2228 BLACK ROCK TPKE, SUITE 211, FAIRFIELD, CT 06825-3237
(203) 375-9350
(203) 375-8013
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
070195
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004267383
—
CT
Enumeration date
07/27/2015
Last updated
07/27/2015
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