MEDICARE: LEAH BLAKE MACFARLANE RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1205787538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH BLAKE MACFARLANE RD

Provider Business Mailing Address
First Line	:	288 4TH AVE APT 1005
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2146
Country	:	US
Telephone Number	:	860-948-0891
Fax Number	:

Provider Business Practice Location Address
First Line	:	288 4TH AVE APT 1005
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2146
Country	:	US
Telephone Number	:	860-948-0891
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2026
Last Update Date	:	02/04/2026

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