Healthcare Provider Details

I. General information

NPI: 1427978212
Provider Name (Legal Business Name): MADISON LEE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17526 W HOPE DR
GOODYEAR AZ
85338-5509
US

IV. Provider business mailing address

221 CAMP BROOK RD
OSCEOLA PA
16942-9715
US

V. Phone/Fax

Practice location:
  • Phone: 570-404-4881
  • Fax:
Mailing address:
  • Phone: 570-404-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: