Provider Demographics
NPI:1700697208
Name:AMBROSE, LEYANA CANDICE
Entity type:Individual
Prefix:
First Name:LEYANA
Middle Name:CANDICE
Last Name:AMBROSE
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 1:325 E UNIVERSITY BLVD APT 67
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-7075
Mailing Address - Country:US
Mailing Address - Phone:585-503-5902
Mailing Address - Fax:
Practice Address - Street 1:325 E UNIVERSITY BLVD APT 67
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-7075
Practice Address - Country:US
Practice Address - Phone:585-503-5902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency