Provider Demographics
NPI:1073851119
Name:RIDING, LESLIE A (RD, LDN, CLC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:RIDING
Suffix:
Gender:F
Credentials:RD, LDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CEDAR SQ
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1279
Mailing Address - Country:US
Mailing Address - Phone:774-257-4433
Mailing Address - Fax:
Practice Address - Street 1:13 CEDAR SQ
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1279
Practice Address - Country:US
Practice Address - Phone:774-257-4433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2184133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered