Provider Demographics
NPI:1417640566
Name:ANDERSEN, LESLIE (CDN)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 TUNSTALL RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5959
Mailing Address - Country:US
Mailing Address - Phone:914-574-1566
Mailing Address - Fax:
Practice Address - Street 1:28 TUNSTALL RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5959
Practice Address - Country:US
Practice Address - Phone:914-574-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010818-01133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist