Provider Demographics
NPI:1275089377
Name:WAKSMAN, LEANNE J
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:J
Last Name:WAKSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5205
Mailing Address - Country:US
Mailing Address - Phone:508-862-5565
Mailing Address - Fax:508-862-5961
Practice Address - Street 1:105 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5205
Practice Address - Country:US
Practice Address - Phone:508-862-5565
Practice Address - Fax:508-862-5961
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant