Healthcare Provider Details

I. General information

NPI: 1871318428
Provider Name (Legal Business Name): LEANFITRX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 S 4TH ST STE 209
LAS VEGAS NV
89101-6845
US

IV. Provider business mailing address

5 FRENCHMENS KY
WILLIAMSBURG VA
23185-8621
US

V. Phone/Fax

Practice location:
  • Phone: 251-599-0353
  • Fax:
Mailing address:
  • Phone: 251-599-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELDON SCOTT BRADLEY
Title or Position: NP/OWNER
Credential: NP-C
Phone: 251-599-0353