Healthcare Provider Details

I. General information

NPI: 1043582026
Provider Name (Legal Business Name): LELLIETH KEIZE REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LELLIETH LATCHMAN MS, RDN, CDCES

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 OLD KINGS HWY S STE 200
DARIEN CT
06820-4532
US

IV. Provider business mailing address

14 FERRIS AVE APT 10
NORWALK CT
06854-1538
US

V. Phone/Fax

Practice location:
  • Phone: 203-952-3534
  • Fax: 203-803-4697
Mailing address:
  • Phone: 203-952-9715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number965780
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: