Provider Demographics
NPI:1902370935
Name:FLORY, LESLIE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:FLORY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13919 CRISTO CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1217
Mailing Address - Country:US
Mailing Address - Phone:864-567-9692
Mailing Address - Fax:
Practice Address - Street 1:13919 CRISTO CT
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1217
Practice Address - Country:US
Practice Address - Phone:864-567-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC960500133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered