Healthcare Provider Details

I. General information

NPI: 1245496603
Provider Name (Legal Business Name): AMBER LEIGH RAY RDN, IFNCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER LEIGH BALBACH RDN

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6319 E US HIGHWAY 36 STE 105
AVON IN
46123-6209
US

IV. Provider business mailing address

6319 E US HIGHWAY 36 STE 105
AVON IN
46123-6209
US

V. Phone/Fax

Practice location:
  • Phone: 317-561-0183
  • Fax: 317-342-9449
Mailing address:
  • Phone: 317-561-0183
  • Fax: 317-342-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37002146A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: