Provider Demographics
NPI:1457854150
Name:TABATABAIE, LEANNA (MS, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:TABATABAIE
Suffix:
Gender:F
Credentials:MS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1001
Mailing Address - Country:US
Mailing Address - Phone:570-457-2464
Mailing Address - Fax:570-457-2492
Practice Address - Street 1:532 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507
Practice Address - Country:US
Practice Address - Phone:570-457-2464
Practice Address - Fax:570-457-2492
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004448133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered