Healthcare Provider Details

I. General information

NPI: 1568836203
Provider Name (Legal Business Name): LEA CHRISTY LOVELAND R.D.N, C.D.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 11/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 PROSPECT AVE
BRONX NY
10459-3978
US

IV. Provider business mailing address

890 PROSPECT AVE
BRONX NY
10459-3978
US

V. Phone/Fax

Practice location:
  • Phone: 718-991-0605
  • Fax: 347-498-2751
Mailing address:
  • Phone: 718-991-0605
  • Fax: 347-498-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number008515
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number008515
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number008515
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: