Provider Demographics
NPI:1245994243
Name:KELLY, LESLIE L (RD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:KELLY
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 1:1766 ROUTE 67
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:NY
Mailing Address - Zip Code:12451-1258
Mailing Address - Country:US
Mailing Address - Phone:518-391-8134
Mailing Address - Fax:
Practice Address - Street 1:1938 CURRY RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-3902
Practice Address - Country:US
Practice Address - Phone:518-382-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered