Provider Demographics
NPI:1144338120
Name:GARDNER-SCHAUDER, LEORA JOSEPHA (PHD)
Entity type:Individual
Prefix:DR
First Name:LEORA
Middle Name:JOSEPHA
Last Name:GARDNER-SCHAUDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 YAMATO RD
Mailing Address - Street 2:STE 106-333
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4704
Mailing Address - Country:US
Mailing Address - Phone:561-414-1650
Mailing Address - Fax:561-423-7961
Practice Address - Street 1:1499 W PALMETTO PARK RD
Practice Address - Street 2:STE 172
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3328
Practice Address - Country:US
Practice Address - Phone:561-414-1650
Practice Address - Fax:561-423-7961
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5116103TC0700X
NC4271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002347800Medicaid
FL002347800Medicaid
NCQ39721AMedicare PIN