Provider Demographics
NPI:1346819901
Name:ELLIS, LEEJOY LEEJOY (ND)
Entity Type:Individual
Prefix:
First Name:LEEJOY
Middle Name:LEEJOY
Last Name:ELLIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31100 PINETREE RD STE 218
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5964
Mailing Address - Country:US
Mailing Address - Phone:216-450-1016
Mailing Address - Fax:
Practice Address - Street 1:31100 PINETREE RD STE 218
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5964
Practice Address - Country:US
Practice Address - Phone:216-450-1016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty