Provider Demographics
NPI:1376037739
Name:WILLIAMS, LESLIE SHEPHERD
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:SHEPHERD
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5154
Mailing Address - Country:US
Mailing Address - Phone:336-269-1269
Mailing Address - Fax:919-354-7075
Practice Address - Street 1:3015 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5154
Practice Address - Country:US
Practice Address - Phone:336-269-1269
Practice Address - Fax:919-354-7075
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL004446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered