Provider Demographics
NPI:1669099172
Name:STANFORD, LESLEY GRAYCE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:GRAYCE
Last Name:STANFORD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 HANES HOUSE DUKE UNIVERSITY MEDICAL CENTER ROOM 375
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-5068
Mailing Address - Fax:919-684-4836
Practice Address - Street 1:1509 RIDGE LN
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9425
Practice Address - Country:US
Practice Address - Phone:919-684-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000608133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered