Healthcare Provider Details

I. General information

NPI: 1861373193
Provider Name (Legal Business Name): PEYTON LESSARD RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SAINT ALPHONSUS ST APT 514
BOSTON MA
02120-1717
US

IV. Provider business mailing address

4 NORTHVILLE AVE
E BRIDGEWTR MA
02333-1255
US

V. Phone/Fax

Practice location:
  • Phone: 617-894-5699
  • Fax:
Mailing address:
  • Phone: 617-894-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLDN8368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: