Provider Demographics
NPI:1356511414
Name:SANFORD, LESLIE ANN (RD, LDN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ANN
Last Name:SANFORD
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1685
Mailing Address - Country:US
Mailing Address - Phone:857-302-2964
Mailing Address - Fax:857-214-4912
Practice Address - Street 1:847 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1685
Practice Address - Country:US
Practice Address - Phone:857-302-2964
Practice Address - Fax:857-214-4912
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1094133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered