Provider Demographics
NPI:1376773564
Name:ROBERTS, LEAH ELIZABETH (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:ELIZABETH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:ELIZABETH
Other - Last Name:NAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE, CSSD, LDN
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GEORGE G MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7081
Mailing Address - Country:US
Mailing Address - Phone:301-677-8513
Mailing Address - Fax:
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-7081
Practice Address - Country:US
Practice Address - Phone:301-677-8513
Practice Address - Fax:850-729-9462
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered