Provider Demographics
NPI:1093398430
Name:STEELE, BENJAMIN DELEON (RD, LD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:DELEON
Last Name:STEELE
Suffix:
Gender:M
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 1:4121 DUESENBERG DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7532
Mailing Address - Country:US
Mailing Address - Phone:779-315-4670
Mailing Address - Fax:
Practice Address - Street 1:4121 DUESENBERG DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7532
Practice Address - Country:US
Practice Address - Phone:770-315-4670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered