Provider Demographics
NPI:1629826235
Name:BEALUKA, LEANDRO VINICIUS (MD)
Entity type:Individual
Prefix:
First Name:LEANDRO
Middle Name:VINICIUS
Last Name:BEALUKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NORTH CLAYTON STREET
Mailing Address - Street 2:MSB 259
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805
Mailing Address - Country:US
Mailing Address - Phone:302-575-8040
Mailing Address - Fax:302-483-2356
Practice Address - Street 1:701 NORTH CLAYTON STREET
Practice Address - Street 2:MSB 259
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-575-8040
Practice Address - Fax:302-483-2356
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DEC7-0018690390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program