Active NPI
Petal Candace Leuwaisee, RDH
- Dental Hygienist
- New York, NY
National Provider Identifier
1578640074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 022881
- Practice address
- 530 1St Ave
Suite9 QQ
New York, NY 10016-6402 - Phone
- (121) 299-8989
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 022881 | NY | Primary |
Addresses
Primary practice location
530 1St Ave
Suite9 QQ
New York, NY 10016-6402
Mailing address
989 E 108TH St
Suite 3C
Brooklyn, NY 11236-3055
Phone (718) 649-0818
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022881 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443139200000",
"number": "1578640074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "989 E 108TH ST",
"address_2": "SUITE 3C",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112363055",
"telephone_number": "718-649-0818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "530 1ST AVE",
"address_2": "SUITE9 QQ",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100166402",
"telephone_number": "121-299-8989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEUWAISEE",
"first_name": "PETAL",
"middle_name": "CANDACE",
"name_prefix": "Miss",
"credential": "RDH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2015-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "NY",
"license": "022881",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.