Malliany Camejo Leonor

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME145242 Issued in FL

Practice address

11921 Saradrienne LN
Bonita Springs, FL 34135-5911

Phone

(393) 442-3532

Fax

(239) 992-4984

NPI assigned

Jul 7, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1499385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629158400000",
    "number": "1952823379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919771",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328919771",
            "telephone_number": "239-278-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11921 SARADRIENNE LN",
            "city": "BONITA SPRINGS",
            "state": "FL",
            "postal_code": "341355911",
            "telephone_number": "393-442-3532",
            "fax_number": "239-992-4984"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19701 S Tamiami Trl",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339084818",
            "country_code": "US",
            "telephone_number": "239-314-1660",
            "fax_number": "239-425-6404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMEJO LEONOR",
        "first_name": "MALLIANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-07",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME145242",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "MN964",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106651300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle Aaron Burton, M.D.
• Maria Ximena Bustamante, PA-C
• C M Wallace DDS PA
• Zaida Camba
• Cambridge Medical Clinic of Florida, LLC
• Tiffany Marie Candy
• Leydis Cantillo
• Yensi Capaz
• Cape Coral Eye Center, P.a. (Tyson Eye at Bonita Eye Center)
• Cape Family Health PA

• Pediatrics Physician in Bonita Springs, FL
• Providers in Bonita Springs, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.