Provider Demographics
NPI:1912790213
Name:BUSTAMANTE ECHEVERRY, LEIDY KATHERINE
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:KATHERINE
Last Name:BUSTAMANTE ECHEVERRY
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 1:2701 NW 23RD BLVD APT P127
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-2935
Mailing Address - Country:US
Mailing Address - Phone:352-871-9251
Mailing Address - Fax:
Practice Address - Street 1:2701 NW 23RD BLVD APT P127
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-2935
Practice Address - Country:US
Practice Address - Phone:352-871-9251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist