Healthcare Provider Details

I. General information

NPI: 1942917448
Provider Name (Legal Business Name): SUSAN LYNN LESLIE MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 BALLANTYNE COMMONS PKWY STE 221
CHARLOTTE NC
28277-3416
US

IV. Provider business mailing address

3051 PRIMROSE LANE
YPSILANTI MI
48197-3213
US

V. Phone/Fax

Practice location:
  • Phone: 704-995-3434
  • Fax:
Mailing address:
  • Phone: 734-604-8266
  • Fax: 833-315-0019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: