Provider Demographics
NPI:1679289284
Name:BORIA, ASHLEIGH RYAN (RD)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:RYAN
Last Name:BORIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:RYAN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:42269 HAMMILL LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2536
Mailing Address - Country:US
Mailing Address - Phone:810-877-2815
Mailing Address - Fax:
Practice Address - Street 1:35055 W 12 MILE RD STE 250
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3270
Practice Address - Country:US
Practice Address - Phone:734-790-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1038940133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered