Provider Demographics
NPI:1366485526
Name:LEYSHOCK, PATTY (RD)
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:
Last Name:LEYSHOCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-1078
Mailing Address - Country:US
Mailing Address - Phone:724-836-8186
Mailing Address - Fax:
Practice Address - Street 1:UNIONTOWN HOSPITAL
Practice Address - Street 2:500 WEST BERKELEY STREET
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401
Practice Address - Country:US
Practice Address - Phone:724-430-5052
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered