Provider Demographics
NPI:1003019415
Name:SULLIVAN, LEIGH ANNE (RD, LD)
Entity Type:Individual
Prefix:MISS
First Name:LEIGH
Middle Name:ANNE
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 ROLLING KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-3738
Mailing Address - Country:US
Mailing Address - Phone:214-435-9490
Mailing Address - Fax:
Practice Address - Street 1:3116 ROLLING KNOLL DR
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-3738
Practice Address - Country:US
Practice Address - Phone:214-435-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1456133V00000X
TXDT83632133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered