Individual provider Active NPI

Chandler Marie Leskanic, PA-C

  • Physician Assistant
  • Lake Mary, FL
National Provider Identifier
1134948144
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9119331 Issued in FL
Practice address
138 W Crystal Lake Ave Ste 1100
Lake Mary, FL 32746-2959
Phone
(407) 915-6570
NPI assigned
Oct 7, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 9119331 FL Primary

Addresses

Primary practice location

138 W Crystal Lake Ave Ste 1100
Lake Mary, FL 32746-2959

Mailing address

138 W Crystal Lake Ave Ste 1100
Lake Mary, FL 32746-2959
Phone (407) 915-6570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250613001839 FL Practitioner - Physician Assistant 6608387071

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
9119331FLMDPhysician Assistant

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1728259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728259200000",
    "number": "1134948144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 W CRYSTAL LAKE AVE STE 1100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462959",
            "telephone_number": "407-915-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 W CRYSTAL LAKE AVE STE 1100",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327462959",
            "telephone_number": "407-915-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESKANIC",
        "first_name": "CHANDLER",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-07",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9119331",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.