Provider Demographics
NPI:1548310816
Name:LEIDECKER, SHERYL L (MD)
Entity type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:LEIDECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4109 WAKE FOREST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-2508
Mailing Address - Country:US
Mailing Address - Phone:919-250-3478
Mailing Address - Fax:919-250-6272
Practice Address - Street 1:4109 WAKE FOREST RD STE 300
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-2508
Practice Address - Country:US
Practice Address - Phone:919-250-3478
Practice Address - Fax:919-250-6272
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00732208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2012-00732OtherMEDICAL LICENSE
NC2012-00732OtherMEDICAL LICENSE