Provider Demographics
NPI:1396829842
Name:VALENTINE, CHRISTA LEIGH (MS, RD, CDN)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LEIGH
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:CASTLETON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-0069
Mailing Address - Country:US
Mailing Address - Phone:518-225-5017
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGHURST DR STE 109
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2233
Practice Address - Country:US
Practice Address - Phone:518-225-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY48 006227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered