Provider Demographics
NPI:1013518232
Name:HEINEMAN, LESLIE WAYTE (RD)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:WAYTE
Last Name:HEINEMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 EVANDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1530
Mailing Address - Country:US
Mailing Address - Phone:914-806-0334
Mailing Address - Fax:
Practice Address - Street 1:220 EVANDALE RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-1530
Practice Address - Country:US
Practice Address - Phone:914-806-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered