Basic Information
Provider Information
NPI: 1427581289
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TEHRANCHI
FirstName: LEAH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14690 SPRING HILL DR STE 305
Address2:  
City: SPRING HILL
State: FL
PostalCode: 346098102
CountryCode: US
TelephoneNumber: 3522775348
FaxNumber: 3526062857
Practice Location
Address1: 13235 STATE ROAD 52 STE 102
Address2:  
City: HUDSON
State: FL
PostalCode: 346692968
CountryCode: US
TelephoneNumber: 7273788503
FaxNumber: 7278577807
Other Information
ProviderEnumerationDate: 04/09/2017
LastUpdateDate: 07/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XOS16742FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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